Intranasal etripamil effective for conversion of paroxysmal supraventricular tachycardia

1. Median time to sinus conversion was 17.2 minutes in the etripamil group versus 53.5 minutes in the placebo group.

2. Twice as many patients in the etripamil group converted to sinus rhythm than placebo.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Symptomatic supraventricular tachycardia (SVT) can cause severe distress to patients. Current management includes intravenous calcium-channel blockers or adenosine, both of which are administered in a supervised setting. Etripamil is a fast-acting intranasal calcium-channel blocker that may be self-administered, although its effect in patients with SVT is unclear. This randomized controlled trial aimed to evaluate the safety and efficacy of intranasal etripamil for the conversion of paroxysmal SVT to sinus rhythm. The primary outcome was time to escape from paroxysmal supraventricular tachycardia, while a key secondary outcome was the overall conversion rate between etripamil and placebo groups. According to study results, etripamil was superior to placebo with both a higher conversion rate and shorter median time to conversion. However, this study was limited by its reliance on patient self-administration, potentially affecting adherence and consistency.

Click to read the study in The Lancet

Relevant Reading: The Efficacy and Safety of Etripamil Nasal Spray for Acute Paroxysmal Supraventricular Tachycardia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

In-depth [randomized-controlled trial]: Between Oct 13, 2020, and July 20, 2022, 842 patients were screened for eligibility across 160 sites in Europe and North America. Included were patients ≥ 18 years old with symptomatic paroxysmal SVT, as confirmed on electrocardiogram. Altogether 184 patients (99 in etripamil and 85 in placebo) were included in the final analysis. The primary outcome of median time to sinus conversion was substantially less in the etripamil group (17.2 min, 95% confidence interval [CI] 13.4-26.5) versus placebo (53.5 min, 95% CI 38.7-87.3). Similarly, etripamil had a significantly higher conversion rate of SVT to sinus than placebo (64% vs. 31%, hazard ratio [HR] 2.62, 95% CI 1.66-4.15, p<0.0001). Overall, findings from this study suggest that the self-administration of intranasal etripamil is both safe and effective in rapidly converting paroxysmal SVT patients to sinus rhythm.

Image: PD

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