Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

2.50
Hdl Handle:
http://hdl.handle.net/11287/593988
Title:
Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial
Authors:
Appelboam, Andrew; Reuben, Adam; Mann, C.; Gagg, J.; Ewings, P.; Barton, A.; Lobban, T.; Dayer, M.; Vickery, J.; Benger, J.; Revert trial collaborators
Abstract:
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. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. METHODS: We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation 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, sealed, tamper-evident envelopes. Patients and treating clinicians were not masked to allocation. The primary outcome was return to sinus rhythm at 1 min after intervention, determined by the treating clinician and electrocardiogram and confirmed by an investigator masked to treatment allocation. This study is registered with Current Controlled Trials (ISRCTN67937027). FINDINGS: We enrolled 433 participants between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five participants, 214 participants in each group were included in the intention-to-treat analysis. 37 (17%) of 214 participants assigned to standard Valsalva manoeuvre achieved sinus rhythm compared with 93 (43%) of 214 in the modified Valsalva manoeuvre group (adjusted odds ratio 3.7 (95% CI 2.3-5.8; p<0.0001). We recorded no serious adverse events. INTERPRETATION: In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients. FUNDING: National Institute for Health Research.
Citation:
Lancet. 2015 Oct 31;386(10005):1747-53.
Publisher:
Elsevier
Journal:
Lancet
Issue Date:
31-Oct-2015
URI:
http://hdl.handle.net/11287/593988
DOI:
10.1016/S0140-6736(15)61485-4
PubMed ID:
26314489
Additional Links:
http://www.sciencedirect.com/science/article/pii/S0140673615614854
Note:
This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1474-547X
Appears in Collections:
2015 RD&E publications; Emergency Department

Full metadata record

DC FieldValue Language
dc.contributor.authorAppelboam, Andrewen
dc.contributor.authorReuben, Adamen
dc.contributor.authorMann, C.en
dc.contributor.authorGagg, J.en
dc.contributor.authorEwings, P.en
dc.contributor.authorBarton, A.en
dc.contributor.authorLobban, T.en
dc.contributor.authorDayer, M.en
dc.contributor.authorVickery, J.en
dc.contributor.authorBenger, J.en
dc.contributor.authorRevert trial collaboratorsen
dc.date.accessioned2016-01-19T12:38:19Zen
dc.date.available2016-01-19T12:38:19Zen
dc.date.issued2015-10-31en
dc.identifier.citationLancet. 2015 Oct 31;386(10005):1747-53.en
dc.identifier.issn1474-547Xen
dc.identifier.pmid26314489en
dc.identifier.doi10.1016/S0140-6736(15)61485-4en
dc.identifier.urihttp://hdl.handle.net/11287/593988en
dc.description.abstractBACKGROUND: 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. We assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness. METHODS: We did a randomised controlled, parallel-group trial at emergency departments in England. We randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fibrillation 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, sealed, tamper-evident envelopes. Patients and treating clinicians were not masked to allocation. The primary outcome was return to sinus rhythm at 1 min after intervention, determined by the treating clinician and electrocardiogram and confirmed by an investigator masked to treatment allocation. This study is registered with Current Controlled Trials (ISRCTN67937027). FINDINGS: We enrolled 433 participants between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five participants, 214 participants in each group were included in the intention-to-treat analysis. 37 (17%) of 214 participants assigned to standard Valsalva manoeuvre achieved sinus rhythm compared with 93 (43%) of 214 in the modified Valsalva manoeuvre group (adjusted odds ratio 3.7 (95% CI 2.3-5.8; p<0.0001). We recorded no serious adverse events. INTERPRETATION: In patients with supraventricular tachycardia, a modified Valsalva manoeuvre with leg elevation and supine positioning at the end of the strain should be considered as a routine first treatment, and can be taught to patients. FUNDING: National Institute for Health Research.en
dc.language.isoengen
dc.publisherElsevieren
dc.relation.urlhttp://www.sciencedirect.com/science/article/pii/S0140673615614854en
dc.rightsArchived with thanks to the Lancet. Made available Open Access under the CC-­‐BY-­‐NC-­‐ND license.en
dc.titlePostural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trialen
dc.typeJournal Articleen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalLanceten
dc.description.noteThis article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.en

Related articles on PubMed

This item is licensed under a Creative Commons License
Creative Commons
All Items in RD&E Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.