Efficacy of a combined reverse and modified Valsalva maneuver for the cardioversion of paroxysmal supraventricular tachycardia: a retrospective cohort study

To evaluate the efficacy of a combined sequential reverse Valsalva maneuver (RVM) and modified Valsalva maneuver (MVM) compared to the MVM alone for terminating paroxysmal supraventricular tachycardia (PSVT). A multicenter, retrospective cohort study was conducted at four hospitals in China between January 2022 and March 2025. Hemodynamically stable adult patients with ECG-confirmed PSVT were included. Patients were categorized into two groups based on the initial treatment received: a Combined VM group (sequential RVM followed by MVM) and a Modified VM Alone group. The primary outcome was successful cardioversion to sinus rhythm on the first attempt. Secondary outcomes included cumulative success, need for rescue medication, and adverse events. A multivariable logistic regression analysis was performed to adjust for potential confounders, including age, sex, baseline heart rate, prior PSVT history, tachycardia subtype, body mass index, hypertension, and diabetes mellitus. A total of 208 patients were included in the analysis. The baseline characteristics were similar between the two groups. The first-attempt cardioversion success rate was significantly higher in the Combined VM group than in the Modified VM Alone group (59.2% vs. 35.2%; absolute difference, 24.0%; 95% CI, 10.8% to 37.2%; P < 0.001). After multivariable adjustment, the Combined VM group remained independently associated with a significantly higher likelihood of first-attempt cardioversion success (adjusted odds ratio [aOR], 2.79; 95% CI, 1.56 to 4.98; P < 0.001). The cumulative success rate after up to three attempts was also higher in the Combined VM group (80.6% vs. 59.0%; P = 0.001), which was associated with a significantly lower need for rescue medication (19.4% vs. 41.0%; P = 0.001). No serious adverse events were reported. In this retrospective study, a combined strategy of a reverse Valsalva maneuver followed by a modified Valsalva maneuver was associated with a significantly higher rate of successful cardioversion for PSVT compared to the modified Valsalva maneuver alone. This association persisted after adjustment for clinically relevant confounders. These findings suggest the potential of this novel, no-cost maneuver, and warrant confirmation in a large-scale randomized controlled trial.