Lan Qingsu, Han Bing, Wu Fengchao, Peng Yu, Zhang Zheng
The First Clinical Medical College, Lanzhou University, Lanzhou, China; Department of Heart Center, The First Hospital of Lanzhou University, Medical College of Lanzhou University, Chengguan District, Lanzhou 730000, Gansu, China; Key Laboratory of Cardiovascular Diseases of Gansu Province, Medical College of Lanzhou University, Chengguan District, Lanzhou 730000, Gansu, China.
The First Clinical Medical College, Lanzhou University, Lanzhou, China.
Am J Emerg Med. 2021 Dec;50:507-512. doi: 10.1016/j.ajem.2021.08.067. Epub 2021 Aug 31.
Valsalva maneuver (VM) is a simple and easy method for acute termination of supraventricular tachycardia (SVT), while a postural modification to the VM has been suggested to be superior to the standard VM (SVM). The objective of this meta-analysis is to explore the efficacy and safety of the modified VM (MVM) to terminate SVT compared with the SVM.
Extensive literature was conducted using the database such as PubMed, Embase, Web of Science, Cochrane library and included randomized controlled trials (RCTs) assessing the efficacy and safety of the MVM and SVM for SVT. Meta-analysis was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). Statistical analysis was performed using Review Manager 5.4.1 software. The quality of the published studies was evaluated using the Oxford quality scoring system (Jadad scale).
Six RCTs involving 1208 patients were reviewed, including 603 patients in the MVM group and 605 patients in the SVM group. The results of the meta-analysis showed that MVM was found to significantly increase the success rate of the sinus rhythm after single VM (RR = 2.83; 95% CI = 2.19 to 3.66; P < 0.00001), sinus rhythm after multiple VM (RR = 3.83; 95% CI = 2.26 to 6.50; P < 0.00001), and single and multiple VM (RR = 2.85, 95% CI = 2.35 to 3.45; P < 0.00001). MVM also decreased the emergency anti-arrhythmic treatments (RR = 0.70; 95% CI = 0.62 to 0.79; P < 0.00001), and use of adenosine and verapamil (RR = 0.69; 95% CI = 0.61 to 0.78; P < 0.00001). There was no significant difference in adverse events (RR = 1.48; 95% CI = 0.91 to 2.42; P = 0.11) and time in emergency department (ED) (RR = 0.03; 95% CI = -0.17 to 0.23, P = 0.79) between MVM and SVM.
Compared with MVM, the conversion rate of SVT to sinus rhythm was more effective than SVM. MVM also reduced the use of anti-arrhythmic measures and drugs, and had no increased time in ED and adverse events.
瓦尔萨尔瓦动作（VM）是急性终止室上性心动过速（SVT）的一种简单易行的方法，而对VM进行体位改良被认为优于标准VM（SVM）。本荟萃分析的目的是探讨改良VM（MVM）与SVM相比终止SVT的有效性和安全性。
利用PubMed、Embase、Web of Science、Cochrane图书馆等数据库进行广泛检索，纳入评估MVM和SVM治疗SVT有效性和安全性的随机对照试验（RCT）。采用均数差（MD）、相对危险度（RR）和95%置信区间（CI）进行荟萃分析。使用Review Manager 5.4.1软件进行统计分析。采用牛津质量评分系统（Jadad量表）评估已发表研究的质量。
共纳入6项RCT，涉及1208例患者，其中MVM组603例，SVM组605例。荟萃分析结果显示，MVM单次VM后窦性心律成功率显著提高（RR = 2.83；95%CI = 2.19至3.66；P < 0.00001），多次VM后窦性心律成功率显著提高（RR = 3.83；95%CI = 2.26至6.50；P < 0.00001），单次和多次VM后窦性心律成功率显著提高（RR = 2.85，95%CI = 2.35至3.45；P < 0.00001）。MVM还减少了紧急抗心律失常治疗（RR = 0.70；95%CI = 0.62至0.79；P < 0.00001）以及腺苷和维拉帕米的使用（RR = 0.69；95%CI = 0.61至0.78；P < 0.00001）。MVM与SVM在不良事件（RR = 1.48；95%CI = 0.91至2.42；P = 0.11）和急诊科停留时间（RR = 0.03；95%CI = -0.17至0.23，P = 0.79）方面无显著差异。
与SVM相比，MVM将SVT转为窦性心律的转化率更高。MVM还减少了抗心律失常措施和药物的使用，且未增加急诊科停留时间和不良事件。
