[Modified Valsalva maneuver induced an asymptomatic polymorphic ventricular tachycardia]

Area of Science:

• Cardiology
• Electrophysiology

Background:

• Paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal re-entry tachycardia (AVNRT), are frequently managed with vagal maneuvers.
• The modified Valsalva maneuver, involving forced expiration and postural change, demonstrates superior success rates compared to standard techniques.

Purpose of the Study:

• To evaluate the safety and efficacy of the modified Valsalva maneuver in treating PSVT.
• To investigate rare adverse events associated with the modified Valsalva maneuver, specifically ventricular tachycardia induction.

Main Methods:

• A case study of a 44-year-old woman with recurrent PSVT undergoing a modified Valsalva maneuver under continuous ECG monitoring.
• Diagnostic workup included echocardiography, laboratory tests, and electrophysiology study to confirm the diagnosis and assess cardiac function.

Main Results:

• The modified Valsalva maneuver successfully treated the patient's PSVT.
• During the maneuver, a brief, asymptomatic polymorphic ventricular tachycardia (VT) was induced, which resolved spontaneously.
• Electrophysiology confirmed AVNRT, and the patient subsequently underwent successful cryoablation.

Conclusions:

• The modified Valsalva maneuver is a safe and effective first-line treatment for PSVT.
• Healthcare providers should be aware of the potential for induced ventricular arrhythmias, such as VT, during the maneuver.
• Continuous ECG monitoring during the modified Valsalva maneuver is recommended, especially in patients with a history of arrhythmias. Further electrophysiological evaluation and consideration for ablation are warranted if VT occurs.