The modified Valsalva maneuver is a non-invasive vagal maneuver that serves as first-line therapy for the termination of paroxysmal supraventricular tachycardia. To perform this maneuver, begin with the patient in the semi-recumbent position and ask them to blow into a 10cc syringe for 15 seconds. Next, lay the patient supine with legs raised to a 45 degree angle and hold this position for another 15 seconds. This promotes venous return and increases the vagal tone. Finally, return the patient to the semi-recumbent position. In the REVERT trial, the success rate of the modified Valsalva maneuver is 43%. If the maneuver fails, one may consider other vagal maneuvers such as the carotid sinus massage or administration of IV adenosine.
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