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Cited by 226Cardiac Arrhythmias and TreatmentsCardiovascular Syncope and Autonomic DisordersCardiac electrophysiology and arrhythmias

The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.

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

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Appelboam, Andrew, Reuben, Adam, Mann, Clifford, Gagg, James, Ewings, Paul, Barton, Andrew, Lobban, Trudie, Dayer, Mark, Vickery, Jane, Benger, Jonathan·2015·The Lancet
DOI 10.1016/s0140-6736(15)61485-4
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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.

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Research works printed but not linked: 3

  1. Cohn, 1914, Paroxysmal tachycardia and the effect of stimulation of the vagus nerves by pressure, Heart, 5, 93
  2. Chance, 1998, Augmented valsalva manoeuvre for supraventricular tachycardia in the young, J Clin Neurophysiol, 15, 535
  3. Gagg J. Southwest SVT survey: current Valsalva manoeuvre techniques in adults with supraventricular tachycardia. EMTA Conference, April 13–15, 2011, Bristol, UK (poster).

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Metadata

Authors
Appelboam, A., Reuben, A., Mann, C., Gagg, J., Ewings, P., Barton, A., Lobban, T., Dayer, M., Vickery, J., & Benger, J.
Affiliations
  • Royal Devon & Exeter NHS Foundation Trust (GB)
  • Musgrove Park Hospital (GB)
  • University of Exeter (GB)
  • University of Plymouth (GB)
  • University of the West of England (GB)
Corresponding author
Appelboam, Andrew
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2015-10
Volume
386
Issue
10005
Pages
1747-1753
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(15)61485-4
OpenAlex
W2154338430
Cited by
226
References
18
Citations by year
2026: 23 · 2025: 26 · 2024: 24 · 2023: 20 · 2022: 13 · 2021: 21 · 2020: 27 · 2019: 20 · 2018: 8 · 2017: 19 · 2016: 20 · 2015: 5
FWCI
12.60
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UWE Research Repository (UWE Bristol) (submittedVersion, cc-by-nc-nd)
  • Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion, other-oa)
Funders
National Institute for Health Research through its Research for Patient Benefit Programme (grant number PB-PG-0211-24145)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
supraventricular tachycardia, Valsalva maneuver, passive leg raising, sinus rhythm restoration, emergency department care, cardioversion
MeSH terms
Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Posture, Tachycardia, Supraventricular, Valsalva Maneuver, Supine Position, Treatment Outcome

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