BACKGROUND: The Valsalva manoeuvre is an internationally recommended treatment for @entity4710 , but cardioversion is rare in practice (5-20%), necessitating the use of other treatments including @entity859 , which @entity1 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 @entity4710 (excluding @entity955 ) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the @entity6475 ), 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. @entity1 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 @entity1 between Jan 11, 2013, and Dec 29, 2014. Excluding second attendance by five @entity1 , 214 @entity1 in each group were included in the intention-to-treat analysis. 37 (17%) of 214 @entity1 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 @entity1 with @entity4710 , 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 @entity1 . FUNDING: National Institute for Health Research.

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

@entity1 :: ('9606', 'Species') :: ['participants', 'Patients', 'patients'] @entity859 :: ('MESH:D000241', 'Chemical') :: ['adenosine'] @entity6475 :: ('MESH:D013180', 'Disease') :: ['Valsalva strain'] @entity955 :: ('MESH:D001281', 'Disease') :: ['atrial fibrillation and flutter'] @entity4710 :: ('MESH:D013617', 'Disease') :: ['supraventricular tachycardia']
@entity4710 :: (MESH:D013617,Disease) :: ['supraventricular tachycardias']
