Difference atrioventricular node effect of vagal reflex in standard and modified Valsava maneuver

Author : M. Syarif, S. B Raharjo, B. Radi, D. Yugo, D. A. Hanafi, Y. Yuniadi
Upload Date : 19-04-2018

Background: Vagal maneuver is a first line treatment for patient with stable supraventrikular tachycardia. Previous study showed prolongation of AH interval in Valsava maneuver. The electrophysiological mechanism of modified Valsava manuerver is not well understood.

Aim: To understand the electrophysiological mechanism of modified Valsava maneuver in SVT patient.

Method: Patient with supraventricular tachycardia (SVT) scheduled for electrophysiological study and/or ablation procedure in National Cardiovascular Centre Harapan Kita (NCCHK). SVT was induced in these patient and pre-manuever data was collected, then standard Valsava and modified Valsava was performed with crossover design. Electrophysiological and hemodynamic data was then analyzed up to 1 minute after the maneuvers.

Result: From 16 SVT patients, DAH interval in phase 4 of standard Valsava maneuver was 10.6 + 28.6 ms dan DAH interval in phase 4 of modified Valsava maneuver was 35 + 27.6 ms compared to pre-manuever data. Significant increase of 24.4 + 27.6 ms (p=0,003) in DAH interval in phase 4 for modified Valsava maneuver was achieved compared to standar Valsava maneuver.

Conclusion: Increase vagal response in modified Valsava was shown by prolongation of AH interval compared to standard valsava maneuver.

KEYWORDS : Vagal maneuver, Valsava maneuver, modified Valsava maneuver, supraventricular tachycardia. AH interval

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