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Dr Andy Appelboam

Consultant Emergency Physician
Royal Devon & Exeter NHS Foundation Trust

The REVERT Trial: Randomised Evaluation of Valsalva Effectiveness in Re-Entrant Tachycardias. The Valsalva manoeuvre (VM) is an internationally recommended treatment for supraventricular tachycardia (SVT), but has a low rate of cardioversion success in practice (5-20%), necessitating the use of other treatments including adenosine, which patients often find extremely unpleasant. This trial aimed to evaluate a revised VM involving a simple modification to the usual procedure: the patient is asked to blow into a tube against resistance (as usual) but at the end is laid flat and his or her legs are raised in the air for 15 seconds. The trial demonstrated that the modified VM had a far higher cardioversion rate – 43.5% success rate vs 17.5% in the control group using the usual VM.The trial was funded by the NIHR RfPB programme, with considerable input from the RDS. The initial team attended the annual RDS Residential Research Retreat where the basic idea was firmed up and considerable progress made on developing a grant application. When the proposal was submitted, it was initially rejected but with a strong encouragement to submit a revised version. With continuing help from the RDS a stronger application was submitted which was successful.

The REVERT trial was successfully completed - in fact it over-recruited - and has published in The Lancet and attracted considerable interest in the UK and globally.

Lead applicant and chief investigator Dr Andy Appelboam says: "Without a doubt, the time spent with the RDS on the initial research retreat and the subsequent support we received, was a major factor in the success of our trial. Ensuring the methodology and many other facets of the research had been thought through in such detail meant our trial was designed fit for purpose and with the greatest chance of successful recruitment and high quality conduct.

This combined with well-planned and appropriate analyses, facilitated robust and reliable data which strengthened our case for publication in the highest impact and most widely circulated journal possible. In fact, it was one of the original RDS team, through their understanding of journal priorities and confidence in the nature of our project, who pushed for a submission to The Lancet. A submission which, in no small part due to the support of the RDS, was to the delight of all involved, accepted and published."