Effectiveness of the modified Valsalva maneuver vs the standard Valsalva maneuver for the conversion of supraventricular tachycardia to normal sinus rhythm in the emergency department: a systematic review and meta analysis
- Journal
- Internal and emergency medicine (Q1)
- Published
- 21 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jared Tesch, Caleb Ruziska, Chase Urie, Ryan Brown
- PMID
- 42629535
- DOI
- 10.1007/s11739-026-04505-9
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 23 August 2026): Modified Valsalva vs standard Valsalva for SVT conversion in ED
Abstract
Supraventricular tachycardia (SVT) is a cardiac arrhythmia that is commonly encountered in the emergency department (ED), for which vagal maneuvers represent first-line treatment in hemodynamically stable patients. The modified Valsalva maneuver (MVM), which involves supine repositionings and leg raises that follow the strain phase, have been proposed as a more effective alternative to the standard Valsalva maneuver (SVM). We performed a systematic review and meta-analysis (SRMA) of randomized controlled trials comparing the MVM to the SVM for conversion of SVT to normal sinus rhythm in hemodynamically stable patients presenting to the ED. PubMed, Web of Science, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched from inception through March 17, 2026. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and dichotomous outcomes were pooled as risk ratios (RR) with 95% confidence intervals (CIs). Nine trials comprising 1415 patients were included. The MVM achieved successful cardioversion in 50.1% of patients compared with 18.8% in the SVM group (polled RR 2.63, 95% CI 2.22-3.11; I2 = 0%). No major adverse events were reported in either group. The MVM is significantly more effective than the SVM for terminating SVT in the ED with no major adverse events reported in either group. These findings support the MVM as a safe, low-cost, and reproducible first-line intervention for SVT cardioversion in the ED. Further randomized trials, particularly in pediatric populations and direct comparison with pharmacologic alternatives, are warranted to confirm these results.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.