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{
    "pk": 14796,
    "title": "Randomised Controlled Trial Assessing Head Down Deep Breathing Method Versus Modified Valsalva Manoeuvre for Treatment of Supraventricular Tachycardia in the Emergency Department",
    "subtitle": null,
    "abstract": "Introduction: \nSupraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM). \nMethods:\n We conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects/complications of each technique. \nResults:\n A total of 41 patients were randomised between 1 August, 2018–1 February, 2020 (20 HDDB and 21 modified VM). Amongst the 41 patients, three spontaneously cardioverted to sinus rhythm before receiving the allocated treatment and were excluded. Cardioversion was achieved in six patients (31.6%) and seven patients (36.8%) with HDDB and modified VM, respectively (odds ratio1.26, 95% confidence interval, 0.33, 4.84, P = 0.733) . Seventeen (89.5%) patients in the HDDB group and 14 (73.7%) from the modified VM group did not encounter any adverse effects. No major adverse cardiovascular events were recorded.\nConclusion:\n Both the head down deep breathing technique and the modified Valsalva manoeuvre appear safe and effective in cardioverting patients with SVT in the ED.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Head down deep breathing, Modified Valsalva Manoeuvre, Supraventricular tachycardia"
        }
    ],
    "section": "Critical Care",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/25h4x498",
    "frozenauthors": [
        {
            "first_name": "Hoon Chin",
            "middle_name": "",
            "last_name": "Lim",
            "name_suffix": "",
            "institution": "Changi General Hospital, Accident and Emergency Department, Singapore",
            "department": "None"
        },
        {
            "first_name": "Yi-En Clara",
            "middle_name": "",
            "last_name": "Seah",
            "name_suffix": "",
            "institution": "Changi General Hospital, Accident and Emergency Department, Singapore",
            "department": "None"
        },
        {
            "first_name": "Arshad",
            "middle_name": "",
            "last_name": "Iqbal",
            "name_suffix": "",
            "institution": "Changi General Hospital, Accident and Emergency Department, Singapore",
            "department": "None"
        },
        {
            "first_name": "Vern Hsen",
            "middle_name": "",
            "last_name": "Tan",
            "name_suffix": "",
            "institution": "Changi General Hospital, Cardiology Department, Singapore",
            "department": "None"
        },
        {
            "first_name": "Shieh Mei",
            "middle_name": "",
            "last_name": "Lai",
            "name_suffix": "",
            "institution": "Changi General Hospital, Accident and Emergency Department, Singapore",
            "department": "None"
        }
    ],
    "date_submitted": "2020-12-08T09:49:29+05:30",
    "date_accepted": "2020-12-08T09:49:29+05:30",
    "date_published": "2021-07-21T00:58:26+05:30",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14796/galley/7523/download/"
        }
    ]
}