PROGRESSIVE-AF, RAPID, NOVA, EHANCE-AF Trials Focus on Improving Treatment of Atrial and Supraventricular Arrhythmias

Researchers presenting late-breaking findings from the PROGRESSIVE-AF, RAPID, NOVA and EHANCE-AF trials Nov. 7 during AHA 2022 in Chicago added to the growing body of evidence surrounding the treatment of atrial and supraventricular arrhythmias.

In PROGRESSIVE-AF, first-line catheter ablation was associated with a significantly lower progression to persistent atrial fibrillation (AFib), when compared to initial antiarrhythmic drug therapy. Researchers noted this finding was observed despite enrolling a relatively young population (median age of 58 years) with relatively few comorbidities at baseline outside of hypertension, sleep apnea and obesity. In presenting the findings, Jason G. Andrade, MD, noted that on long-term follow-up, first-line ablation was also associated with significant reduction in any arrhythmia recurrence; significantly lower AFib burden; meaningful improvements in quality of life and symptoms; lower rates of health care utilization; and similar or lower rates of adverse events.

With RAPID, researchers evaluated the efficacy and safety of etripamil nasal spray for the termination of spontaneous paroxysmal supraventricular tachycardia (PSVT) in patients experiencing an episode in an at-home setting. In presenting the findings, James E. Ip, MD, FACC, said the study achieved its primary efficacy endpoint of terminating PSVT with self-administered etripamil using symptom-based optional repeat dosing (HR 2.62, p<0.001). He noted that conversion of PSVT to sinus rhythm was 64.3% at 30 minutes and 73.5% at 60 minutes, with the median time to conversion at 17.2 minutes in the etripamil group compared with 53.5 minutes in the placebo group. There was also a significant reduction in emergency department utilization and medical intervention. "These results demonstrate a potential management strategy for patients to self-treat episodes with etripamil in a medically unsupervised setting," he said.

Results from the phase-2, dose-ranging NOVA study found no significant differences in the rate of postoperative atrial fibrillation (POAF) in cardiac surgery patients who received either 125U or 250U doses of botulinum toxin type A (AGN-151607) compared with placebo. In presenting the findings, Jonathan P. Piccini, MD, MHS, FACC, noted that subgroup analyses suggested a lower rate of POAF and rehospitalization in patients undergoing isolated CABG and in patients >65 years who received 125U of AGN-151607. He added that the mechanism of AFib suppression with botulinum toxin may be related to both direct autonomic influences and decreased inflammation.

In ENHANCE-AF, researchers found that implementation of a novel shared decision-making toolkit designed for low health literacy achieved significantly lower decisional conflict and improved preparation for decision-making compared to usual care in patients with AFib. "We used a process called design thinking to develop our tool, including patient interviews, patient centered design, and iterative patient testing," said Paul J. Wang, MD, FACC. "Our tool is a web-based app that will run on a PC, phone, laptop, or tablet, and offered in English and Spanish." Wang and colleagues note that the patient- and clinician-centered end-user approach to the design of their toolkit "has potential application to other clinical contexts, particularly technically complex issues where patient preference can affect the balance between benefits and harms."

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: AHA Annual Scientific Sessions, AHA22, Anticoagulants, Atrial Fibrillation, Benzoates, Botulinum Toxins, Type A, Cardiac Surgical Procedures, Disease Progression, Postoperative Complications, Risk Factors, Tachycardia, Paroxysmal, Tachycardia, Supraventricular

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