Department of PXL-Healthcare, PXL University of Applied Sciences and Arts.
Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Eur J Emerg Med. 2021 Dec 1;28(6):432-439. doi: 10.1097/MEJ.0000000000000862.
Cardiac arrhythmia, specifically paroxysmal supraventricular tachycardia (SVT), accounts for a substantial proportion of emergency medical services resources utilisation. Reconversion requires increasing the atrioventricular node's refractoriness, which can be achieved by vagal manoeuvres, pharmacological agents or electrical cardioversion. There are multiple variants of vagal manoeuvres, including the Valsalva manoeuvre (VM). While the effectiveness of the standard VM has already been systematically reviewed, there has been no such analysis for the modified VM.
Compare the effectiveness of the modified VM versus the standard VM in restoring the normal sinus rhythm in adult patients with supraventricular tachycardia.
Systematic review with meta-analysis of published randomised controlled trials.
The primary outcome was the reconversion to a sinus rhythm. Secondary outcomes included: medication use, adverse events, length of stay in the emergency department and hospital admission.
Five randomised controlled trials were included, with a combined total of 1181 participants. The meta-analysis demonstrated a significantly higher success rate for reconversion to sinus rhythm when using the modified VM compared to the standard VM in patients with an SVT (odds ratio = 4.36; 95% confidence interval, 3.30-5.76; P < 0.001). More adverse events were reported in the modified VM group, although this difference is NS (risk ratio = 1.48; 95% confidence interval, 0.91-2.42; P = 0.11). The available evidence suggests that medication use was lower in the modified VM group than the standard VM group. However, medication use could not be generalised across the different studies. None of the included studies showed a significant difference in length of stay in the emergency department. Only one study reported on hospital admission, with no significant difference between the two groups.
The available evidence is highly suggestive to support the use of the modified VM compared to the standard VM in the treatment of adult patients with SVT. Meta-analysis showed a higher success rate, required less medication use, and resulted in an equal number of adverse events. However, these results cannot be regarded as definitive in the absence of higher-quality studies.
心律失常，特别是阵发性室上性心动过速（SVT），占据了相当一部分急救医疗服务资源的利用。复律需要增加房室结的不应期，这可以通过迷走神经操作、药物或电复律来实现。迷走神经操作有多种变体，包括瓦尔萨尔瓦动作（VM）。虽然标准 VM 的有效性已经得到系统的综述，但对于改良 VM 还没有这样的分析。
比较改良 VM 与标准 VM 在恢复成人 SVT 窦性心律中的有效性。
对已发表的随机对照试验进行系统综述和荟萃分析。
主要结果是恢复窦性心律。次要结果包括：药物使用、不良事件、急诊留观时间和住院时间。
共纳入 5 项随机对照试验，共纳入 1181 例患者。荟萃分析显示，在 SVT 患者中，改良 VM 复律为窦性心律的成功率明显高于标准 VM（比值比=4.36；95%置信区间，3.30-5.76；P<0.001）。改良 VM 组报告的不良事件更多，但差异无统计学意义（风险比=1.48；95%置信区间，0.91-2.42；P=0.11）。现有证据表明，改良 VM 组的药物使用量低于标准 VM 组。然而，药物使用不能在不同的研究中推广。纳入的研究均未显示急诊留观时间有显著差异。只有一项研究报告了住院情况，两组之间无显著差异。
现有证据强烈支持在治疗成人 SVT 患者时使用改良 VM 而不是标准 VM。荟萃分析显示，改良 VM 复律的成功率更高，所需药物使用量更少，且不良事件发生率相同。然而，由于缺乏高质量的研究，这些结果不能被视为定论。
