Pediatric SVT- REVert
In adults with SVT, the "REVERT" trial showed that a modified valsalva- where patients blow into a syringe while seated, reclined at about 45 degrees and are subsequently "flipped backwards" to be lying flat on their back with legs elevated at 45 degrees- has a much higher success rate of converting SVT than standard positioning. This study looked to see if this "REVERT" holds true in children.
What did they do? They broke the patients up into 3 groups (no treatment group- spoiler, they stayed in SVT- a modified valsalva group and standard valsava group). Each group had about 30 kids, mean age 13 years. Notably, they didn't enroll anyone under 7 years old thinking that these younger children couldn't really follow the instructions provided.
What did they find? Half of the children in the modified valsalva group converted, one-third of the standard group converted, and again, no surprise, none of the "no treatment" group. There were minimal differences (though technically statistically significant) in length of stay, need for adenosine, and satisfaction that all favored the modified group.
Bottom line: Next time you see a child in SVT, consider the "REVERT" approach- a modified valsalva- in your non-pharmacologic attempts to convert back to normal sinus.
What did they do? They broke the patients up into 3 groups (no treatment group- spoiler, they stayed in SVT- a modified valsalva group and standard valsava group). Each group had about 30 kids, mean age 13 years. Notably, they didn't enroll anyone under 7 years old thinking that these younger children couldn't really follow the instructions provided.
What did they find? Half of the children in the modified valsalva group converted, one-third of the standard group converted, and again, no surprise, none of the "no treatment" group. There were minimal differences (though technically statistically significant) in length of stay, need for adenosine, and satisfaction that all favored the modified group.
Bottom line: Next time you see a child in SVT, consider the "REVERT" approach- a modified valsalva- in your non-pharmacologic attempts to convert back to normal sinus.
