What question did this study set out to answer?

This research compares the effectiveness and safety of modified and standard Valsalva manoeuvres in treating paroxysmal supraventricular tachycardia in the emergency department.

February 21, 2026Open Access

Modified Valsalva Versus Standard Valsalva Manoeuvre in Patients with Paroxysmal Supraventricular Tachycardia in the Emergency Department: A Randomised Trial

Key Result

Modified Valsalva restored sinus rhythm in 26.3% of PSVT patients versus 16.2% with standard Valsalva, but difference was not statistically significant.

Key Points

This research compares the effectiveness and safety of modified and standard Valsalva manoeuvres in treating paroxysmal supraventricular tachycardia in the emergency department.
Conducted a prospective, randomised, parallel-group trial in an emergency department.
Randomised adults with stable PSVT to modified or standard Valsalva manoeuvre.
Modified technique included leg elevation and repositioning after a 40-mmHg strain for 15 seconds.
Primary outcome measured was return to sinus rhythm at 1 minute using electrocardiography.
Sinus rhythm restored in 26.3% of modified Valsalva participants compared to 16.2% in the standard group.
Odds ratio of 0.54 indicates a higher but not statistically significant cardioversion rate for the modified technique.
Both Valsalva techniques were safe with no serious adverse events reported.

Structured PICO

Does a modified Valsalva manoeuvre improve the rate of return to sinus rhythm at 1 minute compared to a standard Valsalva manoeuvre in adults with stable paroxysmal supraventricular tachycardia?

Population

75 adults with stable paroxysmal supraventricular tachycardia (PSVT) in the emergency department of a tertiary care hospital.

Intervention

Modified Valsalva manoeuvre (40-mmHg strain for 15 seconds in a semi-recumbent position followed by immediate supine repositioning with passive leg elevation)

Comparator

Standard Valsalva manoeuvre (40-mmHg strain for 15 seconds in the semi-recumbent position alone)

Outcome

Return to sinus rhythm at 1 minute, confirmed by electrocardiography

The modified Valsalva manoeuvre resulted in a numerically higher but not statistically significant rate of cardioversion for PSVT compared to the standard technique, indicating the need for larger trials.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Vagal manoeuvres, particularly the Valsalva manoeuvre (VM), are recommended as first-line therapy for paroxysmal supraventricular tachycardia (PSVT). We aimed to compare the efficacy and safety of a modified Valsalva manoeuvre with the standard technique in terminating PSVT in the emergency department. This prospective, randomised, parallel-group trial was conducted in the emergency department of a tertiary care hospital. Adults with stable PSVT were randomised (1:1) to receive either a modified or standard Valsalva manoeuvre. The modified manoeuvre involved a 40-mmHg strain for 15 seconds in a semi-recumbent position followed by immediate supine repositioning with passive leg elevation, while the standard manoeuvre comprised a 40-mmHg strain for 15 seconds in the semi-recumbent position alone. The primary outcome was return to sinus rhythm at 1 minute, confirmed by electrocardiography. A total of 75 participants were enrolled (37 in the standard group and 38 in the modified group) on an intention-to-treat basis. Sinus rhythm was restored in 10 of 38 patients (26.3%) in the modified Valsalva group compared with 6 of 37 patients (16.2%) in the standard group (odds ratio 0.54; 95% CI 0.17–1.68; p >0.05). No serious adverse events were observed in either group. The modified Valsalva manoeuvre demonstrated a higher, though not statistically significant, cardioversion rate compared with the standard technique. Both manoeuvres were safe and well tolerated. Larger adequately powered studies are required to establish definitive efficacy.