Supraventricular TachycardiaNASVAL-SVTNCT07617077
NASVAL-SVT: Nasal Swab Versus Modified Valsalva for Supraventricular Tachycardia
A study testing Nasopharyngeal Swab Insertion and Modified Valsalva Maneuver (REVERT Protocol) in people with Supraventricular Tachycardia and Paroxysmal Supraventricular Tachycardia, run by Marmara University Pendik Training and Research Hospital at 1 site in Turkey (Türkiye).
Trial summary
Supraventricular tachycardia (SVT) is a common heart rhythm disorder seen in emergency departments, causing a rapid heartbeat (typically 150-250 beats per minute). The current best non-drug treatment, the modified Valsalva maneuver (mVM), successfully restores normal rhythm in about 43% of cases. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Supraventricular Tachycardia, Paroxysmal Supraventricular Tachycardia, Atrioventricular Nodal Reentry Tachycardia
- What is being tested?
- Nasopharyngeal Swab Insertion and Modified Valsalva Maneuver (REVERT Protocol)
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 1 May 2026to Jun 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age 18 years or older
- Electrocardiographically confirmed supraventricular tachycardia (SVT): narrow QRS complex (≤120 ms), regular rhythm, rapid ventricular rate, documented on 12-lead ECG or continuous cardiac monitoring
- Hemodynamic stability, defined as ALL of the following simultaneously present:
- Systolic blood pressure ≥90 mmHg
- Diastolic blood pressure ≥60 mmHg
- Alert and oriented mental status (GCS 15)
- No signs of acute end-organ dysfunction
- Ability and willingness to provide written informed consent
Who cannot join
- Age younger than 18 years
- Pregnancy (known or suspected)
- Inability to confirm SVT diagnosis by ECG criteria
- Delta wave or pre-excitation pattern on ECG (Wolff-Parkinson-White syndrome or asymptomatic pre-excitation) - due to risk of ventricular fibrillation with vagal maneuvers
- Wide QRS tachycardia (QRS ≥120 ms) where ventricular tachycardia cannot be excluded
- Absolute contraindication to modified Valsalva maneuver (inability to assume supine position or passive leg elevation)
Show all 10Show fewer
- Contraindication to nasal swab (nasal surgery within 30 days, active epistaxis, visible nasal polyp or mass)
- Hemodynamic instability requiring immediate synchronized cardioversion
- Prior enrollment in this study (re-presentation with SVT)
- Refusal to participate
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Marmara University Pendik Training and Research Hospital
Istanbul, Pendik, 34899
Emir Ünal, 05327766010, emirunal@gmail.com
About this study
Official title: A Randomized Controlled Trial Comparing Nasal Swab and Modified Valsalva Maneuver for the Treatment of Supraventricular Tachycardia
Supraventricular tachycardia (SVT) is a common heart rhythm disorder seen in emergency departments, causing a rapid heartbeat (typically 150-250 beats per minute). The current best non-drug treatment, the modified Valsalva maneuver (mVM), successfully restores normal rhythm in about 43% of cases. When these maneuvers fail, intravenous adenosine is used, which, while effective, can cause brief but distressing side effects such as chest tightness, shortness of breath, and intense anxiety.
During the COVID-19 pandemic, some patients briefly fainted during nasal swab collection. This happens because inserting a swab into the back of the nasal cavity (nasopharynx) stimulates the trigeminal nerve, which then activates the vagus nerve and slows the heart - a phenomenon called the trigeminocardiac (or nasocardiac) reflex. One published case report described a patient whose SVT was terminated within 10 seconds using a nasal swab.
Read more
This study compares the nasal swab technique with the modified Valsalva maneuver in patients presenting to the emergency department with SVT. Patients are randomly assigned to one of two groups. The primary outcome is whether a normal heart rhythm is restored within 1 minute of the procedure. Patient comfort and satisfaction are also measured.
The study is conducted in two phases. The first (pilot) phase (30 patients per group) will assess whether the study can be successfully conducted and collect data to finalize the required sample size. The second (main) phase will use the pilot phase's actual data to determine the final number of participants needed.
Read the detailed description
BACKGROUND:
Supraventricular tachycardia (SVT) encompasses re-entrant arrhythmias dependent on the atrioventricular node, including atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular re-entry tachycardia (AVRT). Vagal maneuvers increase parasympathetic tone via the vagus nerve, slowing atrioventricular conduction and terminating these re-entrant circuits. The modified Valsalva maneuver (REVERT protocol) achieves termination in approximately 43% of cases, making it the most effective non-pharmacological approach currently available.
The trigeminocardiac reflex (TCR), also termed the nasocardiac reflex, involves mechanical stimulation of the nasal mucosa and nasopharynx activating the trigeminal nerve (V1/V2 branches) → pterygopalatine ganglion → trigeminal nucleus → dorsal vagal nucleus → cardiac inhibitory parasympathetic output → bradycardia. This reflex has been documented in nasoendoscopy studies (observed in approximately 30% of patients) and was reported to cause syncope during COVID-19 nasopharyngeal swab collection. Hooker and Liebman (2023) reported SVT termination within 10 seconds of nasal swab insertion in a patient refractory to other vagal maneuvers and adenosine. Cinpolat et al. (2025) reported a mean 28% decrease in heart rate and 22% decrease in systolic blood pressure during nasopharyngeal swab procedures, explicitly suggesting SVT as a potential application.
STUDY DESIGN:
Two-phase prospective single-center randomized controlled superiority trial.
- Phase 1 (pilot): 30 participants per arm (n=60 total). Primary aim: feasibility assessment.
- Phase 2 (main): Sample size recalculated from actual pilot-phase conversion rates.
RANDOMIZATION: Computer-generated blocked randomization (block sizes 4 and 6, randomly mixed) stratified by SVT subtype (probable AVNRT / probable AVRT / indeterminate). Allocation concealment using sequentially numbered, sealed, opaque envelopes.
BLINDING: Open-label for participants and care providers; outcome assessor (30-minute satisfaction survey) and statistician are blinded.
INTERVENTIONS:
- Arm 1 (Nasal Swab): Standard nasopharyngeal swab inserted through the right nostril, parallel to the nasal septum, to the nasopharyngeal vault. Held for 10 seconds with gentle rotation, then withdrawn. Patient in 45-degree semi-recumbent position.
- Arm 2 (mVM/REVERT): Forced expiration for 15 seconds into 10 mL syringe barrel, immediately followed by rapid supine repositioning and 45-degree passive leg elevation for 15 seconds.
OUTCOMES: Primary: sinus rhythm conversion at 1 minute (T=60 seconds post-procedure). Secondary: conversion at 3 and 5 minutes; rescue adenosine requirement; procedural discomfort (VAS 0-10); treatment satisfaction (5-point Likert); re-preference; SVT recurrence at 24 hours and 30 days; adverse event profile.
STATISTICAL ANALYSIS: Chi-square or Fisher's exact test for the primary outcome. Results reported as absolute risk difference with 95% CI. Intention-to-treat analysis as the primary; per-protocol analysis as a sensitivity analysis. Benjamini-Hochberg correction for secondary outcomes. Multiple imputation (MICE) for missing data between 5-20%.
SAFETY STOPPING RULES: Immediate procedure termination and rescue therapy for hemodynamic deterioration, arrhythmia worsening, patient request, or serious adverse event. Pilot phase safety stopping rule: ≥3 serious adverse events in either group triggers protocol review.
PILOT FEASIBILITY GO/NO-GO CRITERIA:
- Monthly enrollment rate: ≥5 patients/month
- Protocol adherence rate: ≥85%
- Missing data rate: ≤10%
- 30-day follow-up completion: ≥70%
- Conditions
- Supraventricular Tachycardia, Paroxysmal Supraventricular Tachycardia, Atrioventricular Nodal Reentry Tachycardia, Vagal Maneuver
- Being tested
- Nasopharyngeal Swab Insertion, Modified Valsalva Maneuver (REVERT Protocol)
- Keywords
- SVT, nasal swab, nasocardiac reflex, trigeminocardiac reflex, Valsalva maneuver, REVERT, emergency department
- Medical subject headings
- Tachycardia, Supraventricular, Tachycardia, Ventricular, Tachycardia, Atrioventricular Nodal Reentry, Emergencies
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Nasopharyngeal Swab InsertionProcedure or surgery
A standard nasopharyngeal swab (approximately 15 cm flexible nylon-tipped swab, sterile) is inserted through the right nostril (left if anatomically impeded), directed parallel to the nasal septum along the nasal floor (posteriorly, not superiorly), and advanced until mild resistance is felt at the nasopharyngeal vault. The swab is held in this position for 10 seconds with optional gentle rotation, then slowly withdrawn. The procedure is performed with the patient in a 45-degree semi-recumbent position under continuous cardiac monitoring (ECG, SpO2, NIBP). T=0 is defined as the moment the swab is fully withdrawn. The procedure is performed once; failure leads to rescue therapy (intravenous adenosine) without a second attempt.
Modified Valsalva Maneuver (REVERT Protocol)Procedure or surgery
The modified Valsalva maneuver is performed per the REVERT protocol. The patient, seated at 45 degrees, performs a forced expiration for 15 seconds into the barrel of a 10 mL syringe (aiming to push the plunger back, targeting an expiratory pressure of≥40 mmHg). Immediately upon completion, the patient is rapidly repositioned supine, and both legs are passively elevated to 45 degrees for 15 seconds, then returned to the semi-recumbent position. Total maneuver duration is approximately 30 seconds. T=0 is defined as the moment the patient returns to the semi-recumbent position. The procedure is performed once; failure leads to rescue therapy (intravenous adenosine) without a second attempt.
| Study group | Role | What they receive |
|---|---|---|
| Nasal Swab Group | Experimental | Nasopharyngeal swab insertion per standardized protocol Receives: Procedure: Nasopharyngeal Swab Insertion |
| Modified Valsalva Group | Active comparator | Modified Valsalva maneuver per REVERT protocol Receives: Procedure: Modified Valsalva Maneuver (REVERT Protocol) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Sinus Rhythm Conversion Rate at 1 Minute
Proportion of participants who convert to sinus rhythm within 1 minute of procedure completion (T=60 seconds), as assessed by continuous 12-lead ECG monitoring. T=0 is defined as the moment the intervention is completed (swab withdrawn / patient returned to semi-recumbent position after leg raise). Rhythm is independently verified by two investigators reviewing the ECG rhythm strip recording. Conversion is defined as a dichotomous outcome: yes (sinus rhythm confirmed at T=60 seconds) or no.
Measured: 1 minute after procedure completion
Secondary outcomes (2)
Sinus Rhythm Conversion Rate at 5 Minutes
Proportion of participants who convert to sinus rhythm within 5 minutes of procedure completion, assessed by continuous ECG monitoring.
Measured: 5 minutes after procedure completion
Adverse Events Profile
Incidence and nature of adverse events including but not limited to epistaxis, vasovagal syncope, significant bradycardia (heart rate <40 bpm), hypotension, and respiratory distress, documented on a structured adverse event checklist.
Measured: During procedure and up to 30 minutes after procedure completion
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Jun 2026
- Study start1 May 2026
- Primary completionMay 2027 (estimated)
- Study completionJun 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Supraventricular TachycardiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Marmara University Pendik Training and Research Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07617077
- Sponsor's protocol ID
- 09.2025.299
- Acronym
- NASVAL-SVT
- Status last verified
- May 2026
- First submitted
- 23 May 2026
- Last updated
- 1 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: Yes, individual participant de-identified data (including the data dictionary and statistical analysis plan) will be shared. Data will be available beginning 12 months after primary publication to researchers who provide a methodologically sound proposal. Requests should be directed to the corresponding author (emirunal@gmail.com).
Publications
Hooker EA, Liebman JS. Termination of paroxysmal supraventricular tachycardia by intranasal swab insertion. Am J Emerg Med. 2023 Oct;72:222.e3-222.e4. doi: 10.1016/j.ajem.2023.08.002. Epub 2023 Aug 2.
PubMed 37543444Koskinen A, Tolvi M, Jauhiainen M, Kekalainen E, Laulajainen-Hongisto A, Lamminmaki S. Complications of COVID-19 Nasopharyngeal Swab Test. JAMA Otolaryngol Head Neck Surg. 2021 Jul 1;147(7):672-674. doi: 10.1001/jamaoto.2021.0715.
PubMed 33914064Betlejewski S, Betlejewski A, Burduk D, Owczarek A. [Nasal-cardiac reflex]. Otolaryngol Pol. 2003;57(5):613-8. Polish.
PubMed 14994602Boux I, Tomasello R, Grisoni L, Pulvermuller F. Brain signatures predict communicative function of speech production in interaction. Cortex. 2021 Feb;135:127-145. doi: 10.1016/j.cortex.2020.11.008. Epub 2020 Dec 2.
PubMed 33360757Cinpolat R. Nasocardiac reflex-induced resolution of persistent hiccups via intranasal swab stimulation: A case report. Am J Emerg Med. 2025 Jun;92:253.e3-253.e4. doi: 10.1016/j.ajem.2025.04.003. Epub 2025 Apr 2.
PubMed 40187990Case LK, Madian N, McCall MV, Bradson ML, Liljencrantz J, Goldstein B, Alasha VJ, Zimmerman MS. Abeta-CT Affective Touch: Touch Pleasantness Ratings for Gentle Stroking and Deep Pressure Exhibit Dependence on A-Fibers. eNeuro. 2023 May 26;10(5):ENEURO.0504-22.2023. doi: 10.1523/ENEURO.0504-22.2023. Print 2023 May.
PubMed 37169581Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, Lobban T, Dayer M, Vickery J, Benger J; REVERT trial collaborators. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015 Oct 31;386(10005):1747-53. doi: 10.1016/S0140-6736(15)61485-4. Epub 2015 Aug 24.
PubMed 26314489
Study at a glance
From the registry record, last updated by the sponsor on 1 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Controlled Trial Comparing Nasal Swab and Modified Valsalva Maneuver for the Treatment of Supraventricular Tachycardia
- ClinicalTrials.gov ID
- NCT07617077
- Acronym / sponsor ID
- NASVAL-SVT / 09.2025.299
- Conditions
- Supraventricular Tachycardia, Paroxysmal Supraventricular Tachycardia, Atrioventricular Nodal Reentry Tachycardia, Vagal Maneuver
- Keywords
- SVT, nasal swab, nasocardiac reflex, trigeminocardiac reflex, Valsalva maneuver, REVERT, emergency department
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Marmara University Pendik Training and Research HospitalUniversity, hospital or other
- Study start
- 1 May 2026 (actual)
- Primary completion
- May 2027 (estimated)
- Study completion
- Jun 2027 (estimated)
- First posted
- 1 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Supraventricular tachycardia (SVT) is a common heart rhythm disorder seen in emergency departments, causing a rapid heartbeat (typically 150-250 beats per minute). The current best non-drug treatment, the modified Valsalva maneuver (mVM), successfully restores normal rhythm in about 43% of cases. When these maneuvers fail, intravenous adenosine is used, which, while effective, can cause brief but distressing side effects such as chest tightness, shortness of breath, and intense anxiety.
During the COVID-19 pandemic, some patients briefly fainted during nasal swab collection. This happens because inserting a swab into the back of the nasal cavity (nasopharynx) stimulates the trigeminal nerve, which then activates the vagus nerve and slows the heart - a phenomenon called the trigeminocardiac (or nasocardiac) reflex. One published case report described a patient whose SVT was terminated within 10 seconds using a nasal swab.
This study compares the nasal swab technique with the modified Valsalva maneuver in patients presenting to the emergency department with SVT. Patients are randomly assigned to one of two groups. The primary outcome is whether a normal heart rhythm is restored within 1 minute of the procedure. Patient comfort and satisfaction are also measured.
The study is conducted in two phases. The first (pilot) phase (30 patients per group) will assess whether the study can be successfully conducted and collect data to finalize the required sample size. The second (main) phase will use the pilot phase's actual data to determine the final number of participants needed.
Detailed description
BACKGROUND:
Supraventricular tachycardia (SVT) encompasses re-entrant arrhythmias dependent on the atrioventricular node, including atrioventricular nodal re-entry tachycardia (AVNRT) and atrioventricular re-entry tachycardia (AVRT). Vagal maneuvers increase parasympathetic tone via the vagus nerve, slowing atrioventricular conduction and terminating these re-entrant circuits. The modified Valsalva maneuver (REVERT protocol) achieves termination in approximately 43% of cases, making it the most effective non-pharmacological approach currently available.
The trigeminocardiac reflex (TCR), also termed the nasocardiac reflex, involves mechanical stimulation of the nasal mucosa and nasopharynx activating the trigeminal nerve (V1/V2 branches) → pterygopalatine ganglion → trigeminal nucleus → dorsal vagal nucleus → cardiac inhibitory parasympathetic output → bradycardia. This reflex has been documented in nasoendoscopy studies (observed in approximately 30% of patients) and was reported to cause syncope during COVID-19 nasopharyngeal swab collection. Hooker and Liebman (2023) reported SVT termination within 10 seconds of nasal swab insertion in a patient refractory to other vagal maneuvers and adenosine. Cinpolat et al. (2025) reported a mean 28% decrease in heart rate and 22% decrease in systolic blood pressure during nasopharyngeal swab procedures, explicitly suggesting SVT as a potential application.
STUDY DESIGN:
Two-phase prospective single-center randomized controlled superiority trial.
- Phase 1 (pilot): 30 participants per arm (n=60 total). Primary aim: feasibility assessment.
- Phase 2 (main): Sample size recalculated from actual pilot-phase conversion rates.
RANDOMIZATION: Computer-generated blocked randomization (block sizes 4 and 6, randomly mixed) stratified by SVT subtype (probable AVNRT / probable AVRT / indeterminate). Allocation concealment using sequentially numbered, sealed, opaque envelopes.
BLINDING: Open-label for participants and care providers; outcome assessor (30-minute satisfaction survey) and statistician are blinded.
INTERVENTIONS:
- Arm 1 (Nasal Swab): Standard nasopharyngeal swab inserted through the right nostril, parallel to the nasal septum, to the nasopharyngeal vault. Held for 10 seconds with gentle rotation, then withdrawn. Patient in 45-degree semi-recumbent position.
- Arm 2 (mVM/REVERT): Forced expiration for 15 seconds into 10 mL syringe barrel, immediately followed by rapid supine repositioning and 45-degree passive leg elevation for 15 seconds.
OUTCOMES: Primary: sinus rhythm conversion at 1 minute (T=60 seconds post-procedure). Secondary: conversion at 3 and 5 minutes; rescue adenosine requirement; procedural discomfort (VAS 0-10); treatment satisfaction (5-point Likert); re-preference; SVT recurrence at 24 hours and 30 days; adverse event profile.
STATISTICAL ANALYSIS: Chi-square or Fisher's exact test for the primary outcome. Results reported as absolute risk difference with 95% CI. Intention-to-treat analysis as the primary; per-protocol analysis as a sensitivity analysis. Benjamini-Hochberg correction for secondary outcomes. Multiple imputation (MICE) for missing data between 5-20%.
SAFETY STOPPING RULES: Immediate procedure termination and rescue therapy for hemodynamic deterioration, arrhythmia worsening, patient request, or serious adverse event. Pilot phase safety stopping rule: ≥3 serious adverse events in either group triggers protocol review.
PILOT FEASIBILITY GO/NO-GO CRITERIA:
- Monthly enrollment rate: ≥5 patients/month
- Protocol adherence rate: ≥85%
- Missing data rate: ≤10%
- 30-day follow-up completion: ≥70%
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Nasal Swab Group | Experimental | Procedure: Nasopharyngeal Swab InsertionNasopharyngeal swab insertion per standardized protocol |
| Modified Valsalva Group | Active comparator | Procedure: Modified Valsalva Maneuver (REVERT Protocol)Modified Valsalva maneuver per REVERT protocol |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Age 18 years or older
- Electrocardiographically confirmed supraventricular tachycardia (SVT): narrow QRS complex (≤120 ms), regular rhythm, rapid ventricular rate, documented on 12-lead ECG or continuous cardiac monitoring
- Hemodynamic stability, defined as ALL of the following simultaneously present:
- Systolic blood pressure ≥90 mmHg
- Diastolic blood pressure ≥60 mmHg
Key exclusion criteria (10 listed)
- Age younger than 18 years
- Pregnancy (known or suspected)
- Inability to confirm SVT diagnosis by ECG criteria
- Delta wave or pre-excitation pattern on ECG (Wolff-Parkinson-White syndrome or asymptomatic pre-excitation) - due to risk of ventricular fibrillation with vagal maneuvers
- Wide QRS tachycardia (QRS ≥120 ms) where ventricular tachycardia cannot be excluded
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Nasopharyngeal Swab InsertionA standard nasopharyngeal swab (approximately 15 cm flexible nylon-tipped swab, sterile) is inserted through the right nostril (left if anatomically impeded), directed parallel to the nasal septum along the nasal floor (posteriorly, not superiorly), and advanced until mild resistance is felt at the nasopharyngeal vault. The swab is held in this position for 10 seconds with optional gentle rotation, then slowly withdrawn. The procedure is performed with the patient in a 45-degree semi-recumbent position under continuous cardiac monitoring (ECG, SpO2, NIBP). T=0 is defined as the moment the swab is fully withdrawn. The procedure is performed once; failure leads to rescue therapy (intravenous adenosine) without a second attempt. | Procedure or surgery | Nasal Swab Group |
| Modified Valsalva Maneuver (REVERT Protocol)The modified Valsalva maneuver is performed per the REVERT protocol. The patient, seated at 45 degrees, performs a forced expiration for 15 seconds into the barrel of a 10 mL syringe (aiming to push the plunger back, targeting an expiratory pressure of≥40 mmHg). Immediately upon completion, the patient is rapidly repositioned supine, and both legs are passively elevated to 45 degrees for 15 seconds, then returned to the semi-recumbent position. Total maneuver duration is approximately 30 seconds. T=0 is defined as the moment the patient returns to the semi-recumbent position. The procedure is performed once; failure leads to rescue therapy (intravenous adenosine) without a second attempt. | Procedure or surgery | Modified Valsalva Group |
Primary outcome
Sinus Rhythm Conversion Rate at 1 Minute
Time frame: 1 minute after procedure completion
Proportion of participants who convert to sinus rhythm within 1 minute of procedure completion (T=60 seconds), as assessed by continuous 12-lead ECG monitoring. T=0 is defined as the moment the intervention is completed (swab withdrawn / patient returned to semi-recumbent position after leg raise). Rhythm is independently verified by two investigators reviewing the ECG rhythm strip recording. Conversion is defined as a dichotomous outcome: yes (sinus rhythm confirmed at T=60 seconds) or no.
2 secondary outcomes
Sinus Rhythm Conversion Rate at 5 Minutes
Time frame: 5 minutes after procedure completion
Adverse Events Profile
Time frame: During procedure and up to 30 minutes after procedure completion
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Jun 2026.
- Results publication: PubMed 37543444Hooker EA, Liebman JS. Termination of paroxysmal supraventricular tachycardia by intranasal swab insertion. Am J Emerg Med. 2023 Oct;72:222.e3-222.e4. doi: 10.1016/j.ajem.2023.08.002. Epub 2023 Aug 2.
- Results publication: PubMed 33914064Koskinen A, Tolvi M, Jauhiainen M, Kekalainen E, Laulajainen-Hongisto A, Lamminmaki S. Complications of COVID-19 Nasopharyngeal Swab Test. JAMA Otolaryngol Head Neck Surg. 2021 Jul 1;147(7):672-674. doi: 10.1001/jamaoto.2021.0715.
- Results publication: PubMed 14994602Betlejewski S, Betlejewski A, Burduk D, Owczarek A. [Nasal-cardiac reflex]. Otolaryngol Pol. 2003;57(5):613-8. Polish.
- Results publication: PubMed 33360757Boux I, Tomasello R, Grisoni L, Pulvermuller F. Brain signatures predict communicative function of speech production in interaction. Cortex. 2021 Feb;135:127-145. doi: 10.1016/j.cortex.2020.11.008. Epub 2020 Dec 2.
- Results publication: PubMed 40187990Cinpolat R. Nasocardiac reflex-induced resolution of persistent hiccups via intranasal swab stimulation: A case report. Am J Emerg Med. 2025 Jun;92:253.e3-253.e4. doi: 10.1016/j.ajem.2025.04.003. Epub 2025 Apr 2.
- Results publication: PubMed 37169581Case LK, Madian N, McCall MV, Bradson ML, Liljencrantz J, Goldstein B, Alasha VJ, Zimmerman MS. Abeta-CT Affective Touch: Touch Pleasantness Ratings for Gentle Stroking and Deep Pressure Exhibit Dependence on A-Fibers. eNeuro. 2023 May 26;10(5):ENEURO.0504-22.2023. doi: 10.1523/ENEURO.0504-22.2023. Print 2023 May.
- Results publication: PubMed 26314489Appelboam A, Reuben A, Mann C, Gagg J, Ewings P, Barton A, Lobban T, Dayer M, Vickery J, Benger J; REVERT trial collaborators. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial. Lancet. 2015 Oct 31;386(10005):1747-53. doi: 10.1016/S0140-6736(15)61485-4. Epub 2015 Aug 24.
- Individual participant dataSharing planned: Yes. Yes, individual participant de-identified data (including the data dictionary and statistical analysis plan) will be shared. Data will be available beginning 12 months after primary publication to researchers who provide a methodologically sound proposal. Requests should be directed to the corresponding author (emirunal@gmail.com).
Related trials for Supraventricular Tachycardia
RecruitingObservational study
Product Performance Report: Evaluate Long-term Reliability & Performance of Medtronic Marketed Cardiac Therapy Products
Arrhythmia, Bradycardia
RecruitingObservational study
AI-Based Differential Diagnosis and Localization of Tachycardia Using ECG: Multicenter Registry (EP-AI ASSIST)
Tachycardia, Paroxysmal Supraventricular Tachycardia
Not yet recruiting
Head-to-Head (H2H) Comparison of Ambulatory Cardiac ECG Monitors in Japan
Atrial Fibrillation (AF), Atrial Flutter
Active, not recruitingPhase 1/2
Treatment of Orthostatic Intolerance
Tachycardia, Chronic Orthostatic Intolerance
Not yet recruitingObservational study
Cardiac Arrhythmias in Pediatric Emergency Department
Arrhythmias, Cardiac, Tachycardia, Supraventricular
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Nasopharyngeal Swab Insertion and Modified Valsalva Maneuver (REVERT Protocol) in people with Supraventricular Tachycardia and Paroxysmal Supraventricular Tachycardia, run by Marmara University Pendik Training and Research Hospital at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 1 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Emir Ünal (+905327766010, emirunal@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Sinus Rhythm Conversion Rate at 1 Minute (time frame: 1 minute after procedure completion). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07617077, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Jun 2026.