Modified Valsalva Maneuver Insturctions

- 43% vs 17% response compared to the standard valsalva maneuver

Per ACLS and AHA guidelines, the first-line treatment for stable AVNRT is vagal maneuvers, such as Valsalva or carotid sinus massage. These maneuvers effectively achieve cardioversion in approximately 28% of patients [5]. However, the efficacy drastically increases when using the “modified Valsalva” technique described in the REVERT trial [6]. In order to complete the maneuver, place the patient at a 30 degree angle, and then have him blow into a 10cc syringe for 15 seconds. Quickly lay the patient flat, and raise his legs to 45 degrees for 15 seconds. Lastly, sit the patient fully upright for 30 seconds (see figure 3). The initial study demonstrated successful conversion to sinus rhythm in 43% of patients [6], with a number needed to treat of 3

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