Emergency. 2018; 6 (1): e22

LE T T E R TO ED I TO R

A Simple Device to Control Valsalva Manoeuvre Strain
Pressure; a Letter to Editor
Isabel FitzGerald1, Andrew Appelboam2∗

1. University of Exeter Medical School, St Lukes Campus, Heavitree Rd, Exeter, EX1 2LU, United Kingdom.

2. Emergency Department, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom.

Received: February 2018; Accepted: April 2018; Published online: 10 April 2018

Cite this article as: A Simple Device to Control Valsalva Manoeuvre Strain Pressure; a Letter to Editor. Emergency. 2018; 6(1): e22.

Dear Editor:

We read with interest the article by Motamedi and col-

leagues about the use of a hand held manometer to mea-

sure strain pressure during Valsalva manoeuvre (VM) treat-

ment of supraventricular tachycardia (SVT) (1). We also used

a manometer in our study (REVERT) of a postural modifica-

tion of the VM and are currently investigating the use of a

simple, single patient use device to control VM strain pres-

sure, NCT number:

NCT03298880 (2, 3). Such a device would be useful as blood

pressure manometers are not always available and cannot be

left with patients and other methods of generating the rec-

ommended strain such as syringes have been shown to be

unreliable (4).

We note that Motamedi’s study demonstrated a cardiover-

sion rate of 14.8% in supine participants, which was similar

to the rate achieved in the REVERT trial by control partici-

pants in the semi recumbent position (17%) (2).

In contrast, participants randomised to the modified VM in

the REVERT trial, had a markedly improved cardioversion

rate of 43% (2). This modification required participants to

perform a 40 mmHg pressure strain for 15 seconds in a semi

recumbent position but with supine repositioning and pas-

sive leg raise immediately after the Valsalva strain. To our

knowledge this is the first trial to study this modification and

was not described in the “new modified version” quoted and

referenced in Motamedi’s paper. To achieve the best car-

dioversion rates, we recommend use of a modified VM as

described above with the strain controlled by a manometer

where possible. A simple, single patient use device designed

to deliver the recommended pressure may be helpful to facil-

itate this in practice and could be kept by patients for future

use (3).

1. Appendix

1.1. Acknowledgements

Not Applicable.

1.2. Author’s contribution

Isabel FitzGerald wrote and Andrew Appelboam edited the

manuscript.

1.3. Conflict of interest

No Conflict of interests.

1.4. Funding and support

Not Applicable.

References

1. Motamedi M, Akbarzadeh MA, Safari S, Shahhoseini

M. Valsalva maneuver using a Handmade Device in

Supraventricular Tachycardia Reversion; a Quasi Experi-

mental Study. Emergency. 2017;5(1):e81.

2. A Appelboam AR, C Mann, J Gagg, P Ewings, A Barton et al.

Postural modification to the standard Valsalva manoeu-

vre for emergency treatment of supraventricular tachycar-

dias (REVERT): a randomised controlled trial: The Lancet;

2015.

3. Testing of a Valsalva Assis Device (VAD) in Healthy Vol-

unteers Performing a Valsalva Manoeuvre. ClinicalTrials-

gov2018.

4. Thornton HS EM, Reynolds JA,Coats TJ. Valsalva using a

syringe: pressure and variation. . 2016;33.

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	Appendix
	References