Valsalva maneuver in atrial fibrillation

I found the below topic in the cardiac arrhythmias archives and thought I should bring it to the attention of the new afibbers on the forum and some of us who haven't read it before, like myself.

I have tried it once with success and once without. Although at the time I didn't know if I was doing it right or not, which I wasn't.

I would be interested if other afibbers would share their experience with this method of returning to NSR.



Valsalva maneuver in atrial fibrillation

ISTANBUL, TURKEY.
Paroxysmal (intermittent) atrial fibrillation is an increasingly common heart arrhythmia. The condition may be associated with heart disease or it may have no known cause in which case it is classified as lone, primary or idiopathic atrial fibrillation (AF). It is believed that the arrhythmia is initiated by irregularities in autonomic tone (imbalances between the sympathetic and parasympathetic nervous systems) which causes a slowed and nonuniform progression of the atrial impulse. This progression is represented by the so-called P-wave dispersion on a standard 12-lead electrocardiogram.

Researchers at the Istanbul Faculty of Medicine now report that the P-wave dispersion during an atrial fibrillation attack is much longer than in normal controls (60 milliseconds vs. 37 milliseconds). Their clinical study involved 27 patients with AF and 27 controls with no history of heart problems. Almost half (48 per cent) of the patients suffered from lone atrial fibrillation. All participants had their electrocardiograms taken before, during, and after performing the Valsalva maneuver (exhaling into a mercury manometer with enough force to reach 35 mm Hg pressure and sustaining this pressure for 20 seconds). The AF patients were evaluated during an attack.

The researchers noted that the P-wave dispersion increased markedly in the controls after performing the Valsalva maneuver (from 37 ms to 47 ms). On the other hand, in the patients the P-wave dispersion declined from 60 to 45 ms indicating a pronounced decrease in sympathetic activity. They conclude that the Valsalva maneuver normalizes the P-wave duration and dispersion in AF patients and suggest that medications that decrease sympathetic tone may be beneficial in converting AF to sinus rhythm.

Tukek, Tufan, et al. Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation.

American Journal of Cardiology, Vol. 85, April 1, 2000, pp. 896- 99

Colin,

There are some similar techniques that can work for adrenergic afibbers. They usually don't work for vagal afibbers as they are increasing the parasympathetic response (but there is no harm in trying).

Quote

Vagal maneuvers: Coughing, holding the breath, immersing the face in cold water, and tensing abdominal muscles as if having a bowel movement are called vagal maneuvers because they increase the tone of the vagus nerve on the heart. Increased vagal tone stimulates release of substances that decrease the heart rate, which in some people, can break the abnormal electrical circuit and stop PSVT.
Carotid massage: Carotid massage can release chemicals to slow the heart rate. Carotid massage is generally limited to young, healthy people because older people are at risk for stroke. In the emergency department, the patient will be connected to a heart monitor because the decrease in heart rate can be dramatic. Carotid massage involves gently pressing and rubbing the carotid artery located in the neck just under the angle of the jaw.

<[www.emedicinehealth.com]

Cheers,

George

I can attest to successful conversion by tensing of the abdominal muscles as it has worked for me on many occasions. I exhale as I tense the muscles, and that seems to eliminate any pressure to the heart. My afib is diagnosed lone but permanent. It is mostly silent but on those occasions during a night when it is notice, the abdominal muscle maneuver reverts me to NSR quickly. Nice that you brought it up for discussion; it may not work for everyone, but there will be value to many.

Yet another way of stimulating vagal tone is to ingest Acetylcholine (in the form of Lecithin granules), which is the principal neurotransmitter secreted by the vagal nerve. Since this substance slows the heart-rate, it will sometimes serve to restore NSR. I have terminated a 3-day siege of ectopics in this manner, utilizing a heaping tablespoon of Lecithin in some water, thus increasing parasympathetic activity.

Colin - thanks for posting this. It never hurts to try. Works for many, but as pointed out, not typically for vagals.

I didn't have success with it, but I certainly did try. When I first joined the forum, PC gave advice for vagals to do exercises that involved upper body...like reps with hand weights to get out of the parasympathetic tone (vagal) which is typical when slowing down for bedtime/sleep and more toward sympathetic. In the early years of my AF, that did seem to work. I did the weight exercises before bed and for a while, that kept me from AF during the night. Then I also learned I was becoming hypoglycemic during sleep so that added another challenge.

Everyone should give the maneuver a try as you can do it easily no matter where you are.

Jackie