• Qingsu Lan, Bing Han, Fengchao Wu, Yu Peng, and Zheng Zhang.
• The First Clinical Medical College, Lanzhou University, Lanzhou, China; Department of Heart Center, The First Hospital of Lanzhou University, Medical College of Lanzhou University, Chengguan District, Lanzhou 730000, Gansu, China; Key Laboratory of Cardiovascular Diseases of Gansu Province, Medical College of Lanzhou University, Chengguan District, Lanzhou 730000, Gansu, China.
• Am J Emerg Med. 2021 Dec 1; 50: 507-512.

BackgroudValsalva maneuver (VM) is a simple and easy method for acute termination of supraventricular tachycardia (SVT), while a postural modification to the VM has been suggested to be superior to the standard VM (SVM). The objective of this meta-analysis is to explore the efficacy and safety of the modified VM (MVM) to terminate SVT compared with the SVM.MethodsExtensive literature was conducted using the database such as PubMed, Embase, Web of Science, Cochrane library and included randomized controlled trials (RCTs) assessing the efficacy and safety of the MVM and SVM for SVT. Meta-analysis was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). Statistical analysis was performed using Review Manager 5.4.1 software. The quality of the published studies was evaluated using the Oxford quality scoring system (Jadad scale).ResultsSix RCTs involving 1208 patients were reviewed, including 603 patients in the MVM group and 605 patients in the SVM group. The results of the meta-analysis showed that MVM was found to significantly increase the success rate of the sinus rhythm after single VM (RR = 2.83; 95% CI = 2.19 to 3.66; P < 0.00001), sinus rhythm after multiple VM (RR = 3.83; 95% CI = 2.26 to 6.50; P < 0.00001), and single and multiple VM (RR = 2.85, 95% CI = 2.35 to 3.45; P < 0.00001). MVM also decreased the emergency anti-arrhythmic treatments (RR = 0.70; 95% CI = 0.62 to 0.79; P < 0.00001), and use of adenosine and verapamil (RR = 0.69; 95% CI = 0.61 to 0.78; P < 0.00001). There was no significant difference in adverse events (RR = 1.48; 95% CI = 0.91 to 2.42; P = 0.11) and time in emergency department (ED) (RR = 0.03; 95% CI = -0.17 to 0.23, P = 0.79) between MVM and SVM.ConclusionCompared with MVM, the conversion rate of SVT to sinus rhythm was more effective than SVM. MVM also reduced the use of anti-arrhythmic measures and drugs, and had no increased time in ED and adverse events.Copyright © 2021. Published by Elsevier Inc.

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