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Conversion of Tachycardia With Etripamil Nasal Spray
Study Questions:
What is the efficacy and safety of etripamil nasal spray for the rapid termination of paroxysmal supraventricular tachycardia (SVT)?
Methods:
This study was performed during electrophysiological testing in patients with previously documented SVT who were induced into SVT prior to undergoing a catheter ablation. Patients in sustained SVT for 5 minutes received either placebo or one of four doses of active compound. The primary endpoint was the SVT conversion rate within 15 minutes of study drug administration. Secondary endpoints included time to conversion and adverse events.
Results:
One hundred and four patients were dosed. Conversion rates from SVT to sinus rhythm were between 65% and 95% in the etripamil nasal spray groups and 35% in the placebo group; the differences were statistically significant (Pearson chi-square test) in the three highest active compound dose groups versus placebo. In patients who converted, the median time to conversion with etripamil was <3 minutes. Adverse events were mostly related to the intranasal route of administration or local irritation. Hypotension occurred predominantly in the highest etripamil dose.
Conclusions:
Etripamil nasal spray rapidly terminated induced SVT with a high conversion rate.
Perspective:
Etripamil is a short-acting L-type calcium-channel blocker with a rapid onset of action when administered as nasal spray. This study showed high efficacy of conversion of SVT to sinus rhythm within a few minutes. In comparison, conventional pill in the pocket approach with oral flecainide with an atrioventricular nodal agent usually converts patients within 30-90 minutes after administration. The results of the present study will have to be confirmed in studies outside of the electrophysiology laboratory, with particular attention paid to the risk of hypotension.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrioventricular Node, Calcium Channel Blockers, Catheter Ablation, Drug Evaluation, Electrophysiology, Flecainide, Hypotension, Nasal Sprays, Tachycardia, Paroxysmal, Tachycardia, Supraventricular
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