Modifying the First-Line Treatment of Supraventricular Tachycardia

Abstract

Purpose: The purpose of this quality improvement project was to educate emergency room providers on the effectiveness of modified Valsalva maneuvers (MVMs) for the termination of supraventricular tachycardia (SVT) and to encourage providers to incorporate this maneuver into their practice. Background: There is no gold standard performance technique for Valsalva maneuvers. Evidence suggests that healthcare providers use indiscriminate methods of Valsalva maneuver instruction. When maneuvers fail, chemical and/or electrocardioversion may be employed to terminate the potentially lethal rhythm. These methods of termination cause patients mental and physical discomfort and can precipitate lethal arrhythmias. Utilizing the standardized MVM approach for termination of SVT increases the success rate of termination thus decreasing reliance on uncomfortable and riskier procedures resulting in increased patient satisfaction and safety. Methods: An online education presentation was delivered to participants via email. After viewing the presentation, participants were asked to complete a retrospective pre and posttest survey. The survey evaluated the participants' perceived knowledge gained after participation as well as intent to change practice. Results: Participants demonstrated a significant increase in knowledge after completing the educational intervention, with 11 (85% ) respondents reporting their knowledge as "above average" post-intervention, compared to 6 (46%) prior. The Wilcoxon Signed-Rank test confirmed a statistically significant improvement in knowledge (W=0, p=0.014). Additionally, 12 (92% ) participants reported an intent to incorporate the MVM into their clinical practice, and 12 (92% ) also expressed confidence in performing the maneuver independently post-education Conclusions: The results suggest that the educational intervention effectively increased emergency room providers' knowledge and confidence in performing the MVM for treating SVT. The majority of participants intend to integrate this evidence-based intervention into their practice, thus increasing the potential for improved patient outcomes and reduced reliance on more invasive procedures. Sustained education and support will be essential to ensure the continued application of this standardized approach in clinical practice.