A simple, safe and cost–free modification to a physical technique used to treat patients in the emergency department with an abnormally fast heart rhythm could improve its effectiveness by more than a quarter, according to a study published in The Lancet.

A safe and internationally recommended first time emergency treatment is a physical treatment called the Valsalva manoeuvre. This is done by attempting to forcibly exhale or strain while keeping the nose and mouth closed. This physical strain, changes the rate and volume of blood returning to the heart and causes a reflex slowing of the heart rate which can return the heart rhythm to a normal rate. While recommended, the standard Valsalva manoeuvre has a low success rate of between five and 20 per cent, which often necessitates the use of other treatments such as a drug called adenosine, which is given by injection. This has significant side effects with many patients reporting a sense of doom or the feeling that they are going to die as the drug is being injected. A research team, led by the Royal Devon and Exeter NHS Foundation Trust, have undertaken a study across ten NHS emergency departments involving more than 400 patients, to investigate whether a modification to posture in the Valsalva manoeuvre would improve its performance in treating patients with an abnormally fast heart rate. This is the first randomised controlled trial to assess the effect of modifying posture in the technique. They found that by repositioning patients immediately after the strain (laying flat with legs lifted by staff to increase blood flow back to the heart), the Valsalva manoeuvre was much more successful in returning the heart rhythm to a normal rate. In the study, only 17.5 per cent of patients using the traditional posture experienced a return to normal heart rate, while for those using the modified posture the success rate was significantly greater, at 43.5 per cent. The findings of the study are significant, because they identify a simple, safe, comfortable–for–the–patient and cost–free method to improve the success of the Valsalva manoeuvre.