Valsalva termination of ventricular tachycardia

Nine patients with recurrent ventricular tachycardia (VT) that could be repeatedly terminated by a Valsalva maneuver are described. In two, the tachycardia would cease for only a few seconds and then resume, whereas in seven, the tachycardia could be permanently and reproducible terminated with a Valsalva maneuver. In all patients the tachycardia ended during the strain phase of the Valsalva maneuver, when blood pressure and radiologic measurement indicated that cardiac dimensions had been reduced dramatically. The speed with which the Valsalva maneuver terminated VT increased in direct proportion to the strain pressure. Maneuvers such as standing or nitroglycerin, which independently reduce cardiac dimensions, enhanced the potency of the Valsalva maneuvers. Pretreatment with atropine or propranolol in four patients did not alter the response of VT to the Valsalva maneuver. Thus, it appears that a strong Valsalva maneuver can terminate some forms of VT, most likely related to an abrupt reduction in cardiac dimensions.