Randomized Clinical Trial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5999-6008
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5999
Efficacy and economic benefits of a modified Valsalva maneuver in patients with paroxysmal supraventricular tachycardia
Wei Wang, Teng-Fei Jiang, Wei-Zhong Han, Lin Jin, Xiao-Jing Zhao, Ying Guo
Wei Wang, Wei-Zhong Han, Lin Jin, Xiao-Jing Zhao, Internal Medicine-Cardiovascular Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Teng-Fei Jiang, Department of Nursing, The First Affiliated Hospital of Shandong First Medical University
Ying Guo, Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Guo Y designed the study; Wang W, Jin L, Jiang TF, and Zhao XJ conducted the research; Han WZ and Wang W analyzed the data and wrote the first draft of the manuscript; Han WZ and Guo Y revised the paper; and all authors contributed to writing or critically reviewing the manuscript.
Supported by Key Research and Development Project of Shandong Province, No. 2016GST201224; and Jinan Clinical Medicine Science and Technology Innovation Plan, No. 201907056.
Institutional review board statement: The study protocol was approved by the ethics committee of Shandong Provincial Hospital Affiliated to Shandong University.
Clinical trial registration statement: This study is registered at Shandong Provincial Hospital Affiliated to Shandong First Medical University. The registration identification number is 2019-084.
Informed consent statement: All study participants or their legal guardian provided informed written consent regarding personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All authors declare no conflict of interest.
Data sharing statement: The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Guo, MSN, RN, Chief Nurse, Department of Nursing, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan 250021, Shandong Province, China. guoyingslyy@163.com
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: July 24, 2020
Revised: July 30, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: December 6, 2020
Processing time: 159 Days and 0.6 Hours
Abstract
BACKGROUND

A modified Valsalva maneuver (VM) has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia (PSVT).

AIM

To evaluate the efficacy and economic benefits of a modified VM in Chinese patients.

METHODS

Patients with PSVT admitted to our center between October 2017 and September 2019 were randomly assigned to the modified and standard VM groups. Conversion via VM was performed up to three times. The primary outcome of the study was the success rate of PSVT conversion to sinus rhythm. The secondary outcomes included the incidence of adverse events, economic cost during the visit, and the degree of patient acceptance of the treatment.

RESULTS

Overall, 361 patients were enrolled, with 180 allocated to the modified VM group and 181 to the standard VM group. Baseline characteristics were well matched in the groups. Overall, the modified VM group had higher success rates of PSVT conversion after single (47.78% vs 15.38%, P < 0.001) and multiple (62.22% vs 19.78%, P < 0.001) VM sessions. No significant differences in the incidences of adverse events and rates of patient acceptance were detected between the two groups (both P > 0.05). Moreover, the economic cost of the clinic visit was significantly lower for the modified VM group than for the standard VM group (P < 0.05).

CONCLUSION

The modified VM may confer both therapeutic and economic benefits as compared with the standard VM for conversion of PSVT.

Keywords: Paroxysmal supraventricular tachycardia; Modified Valsalva maneuver; Cost-effective analysis

Core Tip: The modified Valsalva maneuver can increase the pressure in the thoracic cavity and the amount of return heart blood in a short time, thereby increasing left atrial pressure and stimulating the carotid baroreceptor synergistically so as to terminate supraventricular tachycardia. The maneuver is simple and easy to operate, has good safety, a low incidence of adverse reactions, can reduce personal and medical insurance expenses, has good economic benefits, and can be popularized in community hospitals and other primary hospitals.