Supraventricular tachycardia treatment with vagal maneuvers

A living systematic review

Short URL: https://openmetaanalysis.github.io/svt

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Clinical summary: This meta-analysis suggests that the clinical intervention of modified valsalva maneuver is more effective compared to other methods. Network meta-analysis shows that the modified Valsalva maneuver has a 93% probablity of being the most effective vagal manuever for treating supraventricular tachycardia. Forest plot of the two studies that used the modified Valsalva showed that heterogeneity was 'unimportant' (I2 = 0%). The quality of evidence supporting benefit the modified Valsalva is pending due the small number of subjects studied and an unplanned subgroup analysis. We included randomized controlled trials that included the modified Valsalva maneuver for treating supraventricular tachycardia. Additional interpretations may be in the references in the 'Cited by' section below.

Methods overview: We included randomized controlled trials that included the modified Valsalva maneuver for treating supraventricular tachycardia. Studies were abstacted into standardized tables of PICO attributes and risk of bias, and results. This repository updates a previously published meta-analysis.(1) Newer studies included are listed in the references. Rationale for newer trials excluded may be listed at the end of the references.

Results: Details of the studies included are in the:

Below is the forest plot for the primary outcome. Additional Forest plots may be available. Image of forest plot of primary outcome

The Summary of Findings Table (SoF) from the GRADE Profile is below (source files). Image of GRADE Summary of findings table

References:

Systematic review(s)

Most recent review(s) at time of last revision of this repository

  1. Smith GD, Dyson K, Taylor D, Morgans A, Cantwell K. Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD009502. doi: 10.1002/14651858.CD009502.pub2. Review. Update in: Cochrane Database Syst Rev. 2015;(2):CD009502. PMID: 23543578.
  2. Collins NA, Higgins GL 3rd. Reconsidering the effectiveness and safety of carotid sinus massage as a therapeutic intervention in patients with supraventricular tachycardia. Am J Emerg Med. 2015 Jun;33(6):807-9. doi: 10.1016/j.ajem.2015.02.047. Epub 2015 Mar 7. Review. PMID: 25907500

Studies

New Studies not included in the most recent review above

  1. Çorbacıoğlu ŞK, Akıncı E, Çevik Y, Aytar H, Öncül MV, Akkan S, Uzunosmanoğlu H. Comparing the success rates of standard and modified Valsalva maneuvers to terminate PSVT: A randomized controlled trial. Am J Emerg Med. 2017 May 22. pii: S0735-6757(17)30415-1. doi: 10.1016/j.ajem.2017.05.034. [Epub ahead of print] PMID: 28552271.
  2. Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, Lobban T, Dayer M, Vickery J, Benger J; REVERT trial collaborators. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015 Oct 31;386(10005):1747-53. doi: 10.1016/S0140-6736(15)61485-4. Epub 2015 Aug 24. PMID: 26314489.

Studies from the most recent review above

  1. Wen ZC, Chen SA, Tai CT, Chiang CE, Chiou CW, Chang MS. Electrophysiological mechanisms and determinants of vagal maneuvers for termination of paroxysmal supraventricular tachycardia. Circulation. 1998 Dec 15;98(24):2716-23. PubMed PMID: 9851958.
  2. Lim SH, Anantharaman V, Teo WS, Goh PP, Tan A. Comparison of Treatment of Supraventricular Tachycardia by Valsalva Maneuver and Carotid Sinus Massage. Ann Emerg Med. 1998 Jan;31(1):30-35. PMID: 28140013.
  3. Mehta D, Wafa S, Ward DE, Camm AJ. Relative efficacy of various physical manoeuvres in the termination of junctional tachycardia. Lancet. 1988 May 28;1(8596):1181-5. PMID: 2897005.

Studies undergoing review

    Chen C, Tam TK, Sun S, Guo Y, Teng P, Jin D, Xu L, Liu X. A multicenter randomized controlled trial of a modified Valsalva maneuver for cardioversion of supraventricular tachycardias. Am J Emerg Med. 2019 Aug 1:158371. doi: 10.1016/j.ajem.2019.158371. PMID: 31422858.

Studies excluded - selected list of important studies
  1. Honarbakhsh S, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter RJ, Finlay M, Earley MJ, Whitbread M, Schilling RJ. Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial. Heart. 2016 Sep 9. pii: heartjnl-2016-309968. doi: 10.1136/heartjnl-2016-309968. [Epub ahead of print] PMID: 27613170/li>

Funding for this review

  1. None.

Cited by

This repository is cited by:

  1. WikiDoc contributors. Valsalva maneuver. WikiDoc. June 19, 2017. Available at: https://www.wikidoc.org/index.php/Valsalva_maneuver#Treatment_of_supraventricular_tachycardia. Accessed June 17, 2017.