BACKGROUND AND IMPORTANCE: Paroxysmal supraventricular tachycardia (PSVT) is an arrhythmia commonly seen in the emergency department. Both modified Valsalva maneuver (MVM) and intravenous adenosine are the first line treatment, of which the former has e lower success rate while the latter has a higher success rate but some risks and adverse effects. Given both of these reverse rhythms quickly, combining them may achieve a better effect.
OBJECTIVE: The objective of this study is to evaluate the success rate and potential risk of combining the use of intravenous adenosine while patients were doing MVM as a treatment for paroxysmal supraventricular tachycardia(pSVT).
DESIGN, SETTINGS AND PARTICIPANTS: We recruited patients with pSVT from 2017 to 2022, and randomly assigned them into 3 groups, MVM group, intravenous adenosine group, and combination therapy group, in which MVM was allowed to be performed twice, while intravenous adenosine was given in a titration manner to repeat three times, recorded the success rate and side effects in each group.
MAIN RESULTS: The success rate of the MVM group, adenosine group, and combination group are 42.11%, 75.00 and 86.11%, respectively. The success rate of the adenosine group and combination group is significantly higher than the n MVSM group (p < 0.01, p < 0.001), while the success rate of the combination group is higher than the adenosine group, it has no significant difference (p = 0.340). In terms of safety, the longest RR durations (asystole period) are 1.61 s, 1.60s, and 2.27 s, there is a statistical difference among the three groups (p < 0.01) and between the adenosine and combination group (0.018).
CONCLUSION: Therefore, we can conclude that combination therapy has a relatively high success rate and good safety profile, but the current study failed to show its superiority to adenosine.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This RCT compared adenosine, modified valsalva maneuver (MVM), or the combination, to treat paroxysmal supraventricular tachycardia (SVT). No power calculation was reported. The rates of successful cardioversion for the 3 groups were 42%, 75%, and 86%, respectively. The last 2 results were significantly higher than the first, but there was no statistically significant difference between 75% and 86%. Since no power calculation was done, the failure to find a statistically significant difference between the 75% and 86% results cannot be interpreted as showing that no difference actually exists.
Physician rater
This study attempted to answer the interesting question of whether the combination of a Valsalva manoeuvre and adenosine improves the likelihood of reversion of SVT. Although the numbers were small, the combination seems promising.
Physician rater
Supraventricular tachycardia is commonly managed in the emergency department. Valsalva maneuver and intravenous adenosine are the first-line treatments for this form of tachycardia. Although this information is not new, it validates that combining these modalities has a higher success rate.
Physician rater
Interesting hypothesis that never occurred to me. Does not look like may be of additional benefit but was worth investigating.
, McMaster University