Pediatric Cardiology and GUCH Unit, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Int J Cardiol. 2018 Feb 1;252:106-109. doi: 10.1016/j.ijcard.2017.10.120. Epub 2017 Nov 14.
The upside-down position is a little known modified Valsalva manoeuvre (VM). The aim of this study was to investigate the safety and the efficacy of the upside-down position for the treatment of paroxysmal SVT in children.
Twenty-four paediatric patients followed for SVT were enrolled. The patients were assigned (1:1) to a standard VM or to an upside-down position at the first episode of SVT at home. If no cardioversion occurred, a second attempt was undertaken with the other VM. At the patient's first relapse, the intervention protocol was applied in the opposite order at home.
The upside-down position compared to standard VM reached 67% vs 33% rate of cardioversion at a first attempt, followed by 50% vs 0% rate of cardioversion in patients who had failed the first attempt. After having reversed the order of intervention in case of SVT recurrence, we recorded 67% vs 25% and 71% vs 42% success rates in favour of the upside-down position. There were no adverse events.
The upside-down position was safe and tended to be more effective than standard VM for out of hospital SVT treatment. Doctors and parents should be more aware of this effective but overlooked manoeuvre.
倒吊位是一种鲜为人知的改良瓦尔萨尔瓦动作（VM）。本研究旨在探讨倒吊位在儿童阵发性 SVT 治疗中的安全性和疗效。
共纳入 24 例因 SVT 就诊的儿科患者。患者在 SVT 首次发作时（1:1）被分配至标准 VM 或倒吊位。如果未发生电复律，则使用另一种 VM 进行第二次尝试。当患者首次复发时，在家中按相反的顺序应用干预方案。
与标准 VM 相比，倒吊位在首次尝试时的电复律成功率为 67%，而标准 VM 为 33%，首次尝试失败的患者中，倒吊位的电复律成功率为 50%，标准 VM 为 0%。在 SVT 复发时逆转干预顺序后，倒吊位的成功率为 67%，标准 VM 为 25%，倒吊位为 71%，标准 VM 为 42%。没有不良事件发生。
倒吊位安全且对于院外 SVT 治疗的效果优于标准 VM。医生和家长应更加了解这种有效但被忽视的手法。
