Is modified Valsalva maneuver more effective than the standard Valsalva maneuver in terminating paroxysmal supraventricular tachycardia?

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Why is this study important?

The Valsalva maneuver (VM) is a commonly employed first line treatment for paroxysmal supraventricular tachycardia (PSVT).[1][2] Modification of the technique includes supine positioning with either leg elevation or epigastric pressure immediately after the Valsalva strain to increase venous return during the relaxation phase and, thereby, increase vagal stimulation.[3] This study examines whether the modified Valsalva maneuver (MVM) increases termination of PSVT, which could reduce administration of antiarrhythmic medications and their side effects.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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