Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5999
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
Previous studies in western countries suggested that a modified Valsalva maneuver (VM) may improve the success rate of paroxysmal supraventricular tachycardia (PSVT) conversion. However, the relative efficacy and economic benefits of a modified VM as compared with the standard VM in Chinese patients with PSVT have not been evaluated.
The relative efficacy and economic benefits of a modified VM as compared with the standard VM in Chinese patients with PSVT have not been evaluated; therefore, we aimed to compare the clinical efficacy and economic efficiency, as well as the safety of a modified VM vs standard VM in Chinese patients with PSVT.
In this study, we aimed to compare the clinical efficacy and economic efficiency, as well as the safety of a modified VM vs standard VM in Chinese patients with PSVT.
This study included adult patients (aged older than 18 years) with electrocardiography (ECG)-confirmed PSVT who were admitted to the Cardiology Department of Shandong Provincial Hospital between October 2017 and September 2019. All patients were randomized into the modified VM group or standard VM group using opaque-sealed envelopes. Written informed consent was obtained from all participants. Conversion via VM was performed up to three times. The 12-lead ECG or ECG monitoring was used to determine the cardioversion. In both groups, the procedure for standard VM or modified VM was repeated up to 3 times in unresponsive patients. Basic demographics, past history and vital signs of patients in both groups were recorded. The success rates of cardioversion after one or multiple sessions of VM in the two patients groups were recorded. The recovery of sinus rhythm confirmed by ECG was defined as successful cardioversion. Potential adverse events during the performance of the modified or standard VM were observed.
Overall, 361 patients were enrolled, 180 in the modified VM group and 181 in the standard VM group. No significant differences were observed between the two groups in terms of the proportion of males, age, weight, systolic blood pressure, diastolic blood pressure, heart rate, serum potassium at admission, previous onset of PSVT, history of hypertension, coronary heart disease, and prevalence of pneumonia. The success rates of sinus rhythm restoration after a single session or multiple sessions of VM were both higher in patients allocated to the modified VM group than in those allocated to the standard VM group (χ2 values were 33.724 and 22.008, both P < 0.001, respectively). The incidence of adverse events did not differ significantly between the two groups during treatment. Non-serious adverse events occurred in patients in both groups, and the incidences were comparable between the groups. These adverse events resolved spontaneously without any treatment. The average cost of the clinical visit for patients in the modified VM group was RMB 113.32 ± 45.22, whereas that for patients in the standard VM group was RMB 140.91 ± 37.08, which showed that the modified VM is cost-effective compared with standard VM (P < 0.05). According to the scores on the scale of acceptance, acceptance among patients in the modified VM group did not differ statistically from that of patients in the standard VM group (3.67 ± 0.69 vs 3.54 ± 0.66, Kruskal-Wallis test, χ2 = 1.855, P = 0.064).
In summary, the modified VM can effectively improve the success rate of cardioversion in patients with PSVT. The modified VM is effective and involves less cost than standard VM, and the safety and acceptance of the treatments among the PSVT patients were comparable. Termination of PSVT via the modified VM can be managed by primary healthcare professionals and patients themselves.
This study focused on the effect of physical manipulation on supraventricular tachycardia. The intervention scheme was designed by random control, and the effect was evaluated by various evaluation indices. It has important guiding significance for clinical work. 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.