The modified valsalva described in the 2015 REVERT trial has been retrialled multiple times and now undergone meta-analysis clearly showing that modified valsalva is superior to standard vagal maneuvers in reverting SVT.
At the end of the day, the modified valsalva is simple, effective and safe for supraventricular tachycardias, and should be the first thing we try for appropriate patients in ED.
For more info on the REVERT trial and modified valsalva, follow the links below:
- Rebel EM (2022)
- Rebel EM (REVERT 2015)
- The Lancet Video (note: 90 degree leg lift has been shown to be more effective than 45)
- The Bottom Line (REVERT 2015)
LRH EDucation 