{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T15:26:45Z","timestamp":1778513205062,"version":"3.51.4"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T00:00:00Z","timestamp":1620172800000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Ventricular tachycardia (VT) is often misdiagnosed as supraventricular tachycardia with aberrancy. Twelve-lead electrocardiogram remains a key diagnostic tool to differentiate them while providing insights to aid localization of VT. The use of Valsalva manoeuvre (VM) in terminating VT is not conventionally recommended due to lack of robust evidence of its effectiveness and poor understanding of its mechanism in terminating VT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 74-year-old man with history of ischaemic heart disease was admitted with broad complex tachycardia. VT-1 was diagnosed following failed tachycardia termination by adenosine. Haemodynamic compromise necessitated synchronized cardioversion with successful reversion. However, a different VT-2 occurred after cardioversion. VM led to successful termination of VT-2. Subsequently, recurrent episodes of VT-2 occurred with consistent termination by VM. Transthoracic echocardiogram, cardiac magnetic resonance imaging, and a coronary angiogram were performed. Findings suggested that these are likely scar-related VT. VT-1 originated from an anteroseptal scar, whilst VT-2, responsive to VM, likely originated from the Purkinje fibres. Patient remained eurhythmic after Day 1 following amiodarone and beta-blocker initiation. An implantable cardioverter-defibrillator was implanted prior to discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>VM is one of the vagal manoeuvres which are commonly used as initial management of supraventricular tachycardia. Its role in management of VT is obscure. Anecdotal case series recorded its successful use for managing particular VT. Exact mechanism remains elusive although postulated to involve change in cardiac size during strain and release of acetylcholine.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab171","type":"journal-article","created":{"date-parts":[[2021,5,6]],"date-time":"2021-05-06T13:46:18Z","timestamp":1620308778000},"source":"Crossref","is-referenced-by-count":3,"title":["A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4082-2338","authenticated-orcid":false,"given":"Tin Sanda","family":"Lwin","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2353-3964","authenticated-orcid":false,"given":"Rayno Navinan","family":"Mitrakrishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7277-5145","authenticated-orcid":false,"given":"Mohamed","family":"Alama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5620-0798","authenticated-orcid":false,"given":"Shui Hao","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Glenfield Hospital, University of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,5]]},"reference":[{"key":"2021070816551117800_ytab171-B1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1093\/eurheartj\/ehl557","article-title":"A new algorithm in the differential diagnosis of wide complex tachycardia","volume":"28","author":"Dendi","year":"2006","journal-title":"Eur Heart J"},{"key":"2021070816551117800_ytab171-B2","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1161\/01.CIR.62.4.843","article-title":"Valsalva termination of ventricular tachycardia","volume":"62","author":"Waxman","year":"1980","journal-title":"Circulation"},{"key":"2021070816551117800_ytab171-B3","doi-asserted-by":"crossref","first-page":"S412","DOI":"10.1542\/peds.2016-3792","article-title":"Vagal termination of ventricular tachycardia in a pediatric patient","volume":"141","author":"Chaszczewski","year":"2018","journal-title":"Pediatrics"},{"key":"2021070816551117800_ytab171-B4","doi-asserted-by":"crossref","first-page":"2512","DOI":"10.1097\/CCM.0b013e3181a93661","article-title":"Adenosine for wide-complex tachycardia: efficacy and safety","volume":"37","author":"Marill","year":"2009","journal-title":"Crit Care Med"},{"key":"2021070816551117800_ytab171-B5","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1136\/bmj.324.7340.776","article-title":"ABC of clinical electrocardiography: broad complex tachycardia-Part II","volume":"324","author":"Edhouse","year":"2002","journal-title":"BMJ"},{"key":"2021070816551117800_ytab171-B6","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1136\/bmj.324.7339.719","article-title":"Broad complex tachycardia\u2013Part I","volume":"324","author":"Edhouse","year":"2002","journal-title":"BMJ"},{"key":"2021070816551117800_ytab171-B7","first-page":"1122","volume-title":"The ESC Textbook of Cardiovascular Medicine","author":"Camm","year":"2006"},{"key":"2021070816551117800_ytab171-B8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/0002-9343(78)90176-6","article-title":"The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex","volume":"64","author":"Wellens","year":"1978","journal-title":"Am J Med"},{"key":"2021070816551117800_ytab171-B9","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1111\/j.1540-8159.1995.tb04647.x","article-title":"ECG criteria to distinguish between aberrantly conducted supraventricular tachycardia and ventricular tachycardia: practical aspects for the immediate care setting","volume":"18","author":"Drew","year":"1995","journal-title":"Pacing Clin Electrophysiol"},{"key":"2021070816551117800_ytab171-B10","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1161\/CIRCEP.115.002847","article-title":"Twelve-lead ECG of ventricular tachycardia in structural heart disease","volume":"8","author":"de Riva","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021070816551117800_ytab171-B11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15420\/aer.2018.37.2","article-title":"Team management of the ventricular tachycardia patient","volume":"7","author":"Tang","year":"2018","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2021070816551117800_ytab171-B12","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1016\/j.jacc.2017.10.054","article-title":"2017 AHA\/ACC\/HRS Guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"72","author":"Al-Khatib","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2021070816551117800_ytab171-B13","volume-title":"Vagal Maneuver","author":"Niehues","year":"2019"},{"key":"2021070816551117800_ytab171-B14","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1016\/j.jacc.2011.09.014","article-title":"Septal involvement in patients with post-infarction ventricular tachycardia: implications for mapping and radiofrequency ablation","volume":"58","author":"Yoshida","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2021070816551117800_ytab171-B15","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1161\/01.CIR.77.4.759","article-title":"Relationship between the 12-lead electrocardiogram during ventricular tachycardia and endocardial site of origin in patients with coronary artery disease","volume":"77","author":"Miller","year":"1988","journal-title":"Circulation"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/5\/ytab171\/37885418\/ytab171.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/5\/ytab171\/37885418\/ytab171.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:56:10Z","timestamp":1625792170000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytab171\/6267717"}},"subtitle":[],"editor":[{"given":"D'Ascenzi","family":"Flavio","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Habib Rehman","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Debabrata","family":"Bera","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Stefan","family":"Simovic","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Vishal Shahil","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5,3]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytab171","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,5,1]]},"published":{"date-parts":[[2021,5,1]]},"article-number":"ytab171"}}