Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study

2.50
Hdl Handle:
http://hdl.handle.net/11287/593874
Title:
Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study
Authors:
Appelboam, Andrew; Reuben, Adam; Mann, C.; Lobban, T.; Ewings, P.; Benger, J.; Vickery, J.; Barton, A.; Gagg, J.
Abstract:
INTRODUCTION: The Valsalva manoeuvre (VM) is a recommended first-line physical treatment for patients with re-entrant supraventricular tachycardia (SVT), but is often ineffective in standard practice. A failed VM is typically followed by treatment with intravenous adenosine, which patients often find unpleasant. VM effectiveness might be improved by a modification to posture which exaggerates the manoeuvre's vagal response and reduces the need for further emergency treatment. METHODS AND ANALYSIS: This is a multicentre randomised controlled clinical trial in 10 UK emergency departments (EDs). It compares a standard VM with a modified VM incorporating leg elevation and a supine posture after a standardised strain in stable adult patients presenting to the ED with SVT. The primary outcome measure is return to sinus rhythm on a 12-lead ECG. Secondary outcome measures include the need for treatment with adenosine or other antiarrhythmic treatments and the time patients spend in the ED. We plan to recruit approximately 372 patients, with 80% power to demonstrate an absolute improvement in cardioversion rate of 12%. An improvement of this magnitude through the use of a modified VM would be of significant benefit to patients and healthcare providers, and justify a change to standard practice. ETHICS AND DISSEMINATION: The study has been approved by the South West-Exeter Research Ethics Committee (REC reference 12/SW/0281). The trial will be published in an international peer reviewed journal. Study findings will be sent to the European and International resuscitation councils to inform future revisions of arrhythmia management guidelines. RESULTS: The trial will also be disseminated at international conferences and to patients through the Arrhythmia Alliance, a patient support charity. REGISTRATION: The study is registered with Current Controlled Trials (ISRCTN67937027) and has been adopted by the National Institute for Health Research (NIHR) Clinical Research Network.
Citation:
BMJ Open. 2014 Mar 12;4(3):e004525.
Publisher:
BMJ
Journal:
BMJ Open
Issue Date:
1-Mar-2014
URI:
http://hdl.handle.net/11287/593874
DOI:
10.1136/bmjopen-2013-004525
PubMed ID:
24622951
Additional Links:
http://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=24622951
Note:
This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
Type:
Journal Article
Language:
eng
ISSN:
2044-6055
Appears in Collections:
Emergency Department; 2014 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorAppelboam, Andrewen
dc.contributor.authorReuben, Adamen
dc.contributor.authorMann, C.en
dc.contributor.authorLobban, T.en
dc.contributor.authorEwings, P.en
dc.contributor.authorBenger, J.en
dc.contributor.authorVickery, J.en
dc.contributor.authorBarton, A.en
dc.contributor.authorGagg, J.en
dc.date.accessioned2016-01-19T12:36:07Zen
dc.date.available2016-01-19T12:36:07Zen
dc.date.issued2014-03-01en
dc.identifier.citationBMJ Open. 2014 Mar 12;4(3):e004525.en
dc.identifier.issn2044-6055en
dc.identifier.pmid24622951en
dc.identifier.doi10.1136/bmjopen-2013-004525en
dc.identifier.urihttp://hdl.handle.net/11287/593874en
dc.description.abstractINTRODUCTION: The Valsalva manoeuvre (VM) is a recommended first-line physical treatment for patients with re-entrant supraventricular tachycardia (SVT), but is often ineffective in standard practice. A failed VM is typically followed by treatment with intravenous adenosine, which patients often find unpleasant. VM effectiveness might be improved by a modification to posture which exaggerates the manoeuvre's vagal response and reduces the need for further emergency treatment. METHODS AND ANALYSIS: This is a multicentre randomised controlled clinical trial in 10 UK emergency departments (EDs). It compares a standard VM with a modified VM incorporating leg elevation and a supine posture after a standardised strain in stable adult patients presenting to the ED with SVT. The primary outcome measure is return to sinus rhythm on a 12-lead ECG. Secondary outcome measures include the need for treatment with adenosine or other antiarrhythmic treatments and the time patients spend in the ED. We plan to recruit approximately 372 patients, with 80% power to demonstrate an absolute improvement in cardioversion rate of 12%. An improvement of this magnitude through the use of a modified VM would be of significant benefit to patients and healthcare providers, and justify a change to standard practice. ETHICS AND DISSEMINATION: The study has been approved by the South West-Exeter Research Ethics Committee (REC reference 12/SW/0281). The trial will be published in an international peer reviewed journal. Study findings will be sent to the European and International resuscitation councils to inform future revisions of arrhythmia management guidelines. RESULTS: The trial will also be disseminated at international conferences and to patients through the Arrhythmia Alliance, a patient support charity. REGISTRATION: The study is registered with Current Controlled Trials (ISRCTN67937027) and has been adopted by the National Institute for Health Research (NIHR) Clinical Research Network.en
dc.language.isoengen
dc.publisherBMJen
dc.relation.urlhttp://bmjopen.bmj.com/cgi/pmidlookup?view=long&pmid=24622951en
dc.titleRandomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) studyen
dc.typeJournal Articleen
dc.identifier.journalBMJ Openen
dc.description.noteThis article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.en
All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.