Valsalva Maneuver

When I went to the ER for my Afib attack, one of the things the techs did was lower the head of the bed and told me to bear down. At the time, they were trying to get an IV in my neck (after no luck to get one in arms). Anyway, shortly after doing do, i went into NSR. After seeing this video, I'm thinking that they were doing double duty - trying to get a vein AND a version of this maneuver.



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Edited 2 time(s). Last edit at 03/09/2019 10:49AM by katesshadow.

Interesting that in the study <[www.thelancet.com] they excluded patients with afib & flutter.

Valsalva or other vagal maneuvers have been known to be successful in afibbers who are generally adrenergic. Usually doesn't work for those who have a vagal trigger. Just makes you more vagal, whereas it will reverse the high adrenergic tone in those with that trigger.

Glad it worked for you.

Here are some others: would not advise doing #6 <[www.webmd.com] and here is an unusual one: <[www.ncbi.nlm.nih.gov]

Vagal maneuvers are usually more successful with SVT than with afib and flutter.

The “ncbi” link is interesting. Two criteria for cardioversion for the 29 y.o.; one, patient has to be on anti-coagulant and two, a digital rectal exam to eliminate occult blood. The patient converts.

The article, however, does not commit to the digital exam as the only way to convert to sinus because the patient was also put on a beta blocker.

George...correct me, if I’ve misunderstood anything.

So, my question is: I have P-Afig. when next episode occurs, can I do a rectal digital exam on myself as a manuever to convert to sinus? Or would inserting a suppository work?

A digital rectal exam isn’t high on the list of AFIB conversion to NSR methods Catherine. As a potential vagal maneuver of sorts, it could happen occasionally ... and most likely randomly, if at all, rather than consistently since AFIB is not classically terminated consistently by vagal maneuvers. Nevertheless, you could always try it out in your case, though it might be tough performing that trick on one’s self not having an ideal ‘angle’ with which to perform that particular manual gymnastics.

There are other vagal manuevers that might be a little more handy to try in the outside event you might be prone to a vagal conversion of actual AFIB as opposed to SVT or Aflutter, as Carey has rightly indicated should be a bit more likely to convert by such a maneuver than would actual AFIB.

Best wishes,
Shannon

Shannon. honestly, if digital probing converted me to sinus rhythm, I would find a way. Either I’m skipping a beat or this article should be re-written.

I am a newcomer to the miseries of this syndrome and very impressionabe to the various merhods written about or discussed to convert one to sinus. I need to take them with grain.

Honestly, I have no idea of the bed tilting thing they did had anything to do with restoring sinus rhythm. Could have just been a coincidence. And could have been they were just trying to get the IV in and not even trying a maneuver. The video just seemed similar to my experience.

That article makes me chuckle and I'm surprised it got published. I wouldn't put too much stock in a single case report that's really kind of bizarre. If you want to try vagal maneuvers go right ahead. George's link explains several ways to do them and you can find videos on youtube demonstrating them. Like I said earlier, I wouldn't get your hopes up because they rarely work for afib, and I'd definitely save the rectal exam for absolute last, if at all. (But like George said, don't do the carotid massage -- it's potentially dangerous.)

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Catherine
The “ncbi” link is interesting. Two criteria for cardioversion for the 29 y.o.; one, patient has to be on anti-coagulant and two, a digital rectal exam to eliminate occult blood. The patient converts.

The article, however, does not commit to the digital exam as the only way to convert to sinus because the patient was also put on a beta blocker.

George...correct me, if I’ve misunderstood anything.

So, my question is: I have P-Afig. when next episode occurs, can I do a rectal digital exam on myself as a maneuver to convert to sinus? Or would inserting a suppository work?

Catherine,

I would suggest trying #1 to #5 (#6 can carry risk) in this link in my prior post <[www.webmd.com] . I put in the digital rectal article more from an attempt at humor.

If someone has been out of rhythm for some time, it is standard that they be on anticoagulation before trying to convert them. Trying to convert an episode immediately after it starts would likely be low risk. As a previously posted, vagal maneuvers are more likely to work in someone with an adrenergic trigger. However there generally is little downside to trying them. For vagal afibbers, exercise can convert or ward off an episode. This was commonly successful for me in the first two months of my afib career. I've previously written about how excess calcium from food made me much more sensitive and likely to go into afib (this was around 6-7 years ago). Things that never were triggers previously or subsequently to that 18 month period were during that time. The time after orgasm, when the heart rate drops rapidly, became a risk period. I could feel PAC's or the beginning of afib. Just going from horizontal to vertical (i.e. standing up) was often enough to ward off or terminate an episode (don't know which as I wasn't wearing a monitor). Or adding in some light activity. My point is the antidote is the opposite of what the trigger is. If it is an adrenergic trigger, then vagal stimulation may convert or stop an episode. Conversely, if one is vagal, then activity to stimulate the sympathetic nervous system can convert or stop an episode. Either approach generally carries little risk, in my opinion.

George

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katesshadow
Honestly, I have no idea of the bed tilting thing they did had anything to do with restoring sinus rhythm. Could have just been a coincidence. And could have been they were just trying to get the IV in and not even trying a maneuver. The video just seemed similar to my experience.

They were just trying to get an IV. They were using gravity to move blood to your head and neck to expand your jugular vein so they could get a needle in it.