REVERT

Randomised Evaluation of Modified Valsalva Effectiveness in Re-entrant Tachycardias

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 433 adults presenting to the emergency department with supraventricular tachycardia, a modified Valsalva manoeuvre with supine repositioning and passive leg raise more than doubled cardioversion to sinus rhythm at 1 minute compared with the standard semi-recumbent Valsalva manoeuvre.

433

Disegno

Multicentre, randomised, parallel-group controlled trial

Esito

Return to sinus rhythm at 1 minute

Rilevanza

Risultato43 % vs 17 % (adjusted OR 3.7; 95 % CI 2.3–5.8; p<0.0001). No serious adverse events.

Appelboam A, Reuben A, Mann C, et al. Lancet. 2015;386(10005):1747-1753. 10.1016/S0140-6736(15)61485-4

Discussione e critica

Open-label by necessity and single-country, and it reports only immediate cardioversion — nothing about recurrence or length of stay. But the effect is large and the manoeuvre is free, instantaneous and risk-free, which is why vagal manoeuvres are the class-I first-line acute treatment.