How often does Valsalva stop SVT? Not as often as we’d like! The REVERT trial, just published in Lancet, may have discovered the Valsalva maneuver we’ve been looking for to treat patients with supraventricular tachycardia. After usual straining (the classic Valsava), patients were laid flat and had their legs raised for 15 seconds. The results? Forty three percent converted to sinus rhythm compared to 17% with standard Valsava.
Appelboam, Andrew, et al. "Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial." The Lancet (2015). DOI
A splendid review on this article by Rick Body at the St. Emlyn's blog
Kyle S. - September 13, 2015 1:24 AM
Listened to this and a week later tried it on a my first post-podcast SVT. It worked first try, jaded RN staff was impressed and everyone was slapping high fives (even the patient). What a great, useful tip!
K.M. - September 26, 2015 6:41 AM
This worked for me yesterday - pt was ridiculously happy to avoid adenosine! Thanks!!
Dennis H. - September 26, 2015 11:40 AM
Ok. My n of one. 40 week ega sent down from ob with narrow complex rate ~200bpm. I had her blow on a syringe and then elevated her legs (while having her turned to left side) and then....15 sec went by and monitor suddenly showed sinus rate of 90! Impressed the staff! I don't know how many times I have been unsuccessful with valsalva but we may have something with the passive lag raise.
Melody O. - October 19, 2015 11:49 PM
Just tried this right now. A young lady with history of SVTs on a number of cardiac meds, came in with SVT, HR 190s. When asked what worked for her in the past, she stated that she did not like the feeling of electrical cardioversion and adenosine in the past. I suggested to the team to try this modified technique... and it worked! Similar to Kyle S., all the RNs thought we were crazy but overall impressed. Patient was happy to avoid adenosine and EC!