title: Randomised Evaluation of modified Valsalva Effectiveness in Re-entrant Tachycardias (REVERT) study.
abstract: BACKGROUND
  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
  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.
  
  
  BACKGROUND
  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.
  
  
  BACKGROUND
  The study is registered with Current Controlled Trials (ISRCTN67937027) and has been adopted by the National Institute for Health Research (NIHR) Clinical Research Network.
authors.affiliation: Department of Emergency Medicine, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, Devon, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Appelboam
authors.forename: Adam
authors.initials: A
authors.lastname: Reuben
authors.forename: Clifford
authors.initials: C
authors.lastname: Mann
authors.forename: Trudie
authors.initials: T
authors.lastname: Lobban
authors.forename: Paul
authors.initials: P
authors.lastname: Ewings
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benger
authors.forename: Jane
authors.initials: J
authors.lastname: Vickery
authors.forename: Andrew
authors.initials: A
authors.lastname: Barton
authors.forename: James
authors.initials: J
authors.lastname: Gagg
mesh_terms: D000241:Adenosine / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D004562:Electrocardiography; D006801:Humans; D011187:Posture; D013617:Tachycardia, Supraventricular / Q000188:drug therapy / Q000628:therapy*; D014636:Valsalva Maneuver; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: Accident & Emergency Medicine