The Lancet: Postural Modification to the Standard Valsalva Maneuver for Emergency Treatment of Supraventricular Tachycardias (REVERT)

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Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial Andrew Appelboam, FRCEM, Adam Reuben, FRCEM, Clifford Mann, FRCEM, James Gagg, FRCEM, Prof Paul Ewings, PhD, Andrew Barton, MSc, Trudie Lobban, MRCP, Mark Dayer, FRCP, Jane Vickery, MSc, Prof Jonathan Benger, MD on behalf of the REVERT trial collaborators The Lancet. 2015; DOI:10.1016/S0140-6736(15)61485-4 Published Online: 24 August 2015 Background: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. Researchers assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. Methods: The study authors did a randomised controlled, parallel-group trial at emergency departments in England. They randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fi brillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, opaque, …