Have you had one of those resus shifts where everyone and their mother seems to be in an arrhythmia? Have some of them been older patients with SVT that just make you a little antsy about giving medications like adenosine multiple times after Valsalva maneuvers haven’t worked or then having to try an IV beta blocker or IV Ca channel blocker? Have you had those patients who go into paroxysmal SVT a few times a year and basically come in telling you they’re in SVT? Have patients who’ve had adenosine administered in the past told you how uncomfortable it makes them? There could be something new around the corner.
Recently published in the Journal of the American College of Cardiology in July 2018 was a phase 2 study that tested intranasal etripamil, a Ca channel blocker that slows AV nodal conduction with a half life of about 20 minutes. They induced SVT in patients who were going to get catheter ablated anyway. They found that intranasal etripamil was effect in converting SVT to sinus about 65-95% of the time with the median time to conversion being <3 minutes. The most common adverse effect was local nasal irritation. Blood pressure reduction was only seen at the very highest doses of the medication. If ultimately approved, this might be an alternative to our go-to medications and even be a medication that can be self-administered by some patients outside the health care system.
Resources:
Etripamil Nasal Spray for Rapid Conversion of Supraventricular Tachycardia to Sinus Rhythm. Stambler BS, Dorian P, Sager PT, Wight D, Douville P, Potvin D, Shamszad P, Haberman RJ, Kuk RS, Lakkireddy DR, Teixeira JM, Bilchick KC, Damle RS, Bernstein RC, Lam WW, O’Neill G, Noseworthy PA, Venkatachalam KL, Coutu B, Mondésert B, Plat F. J Am Coll Cardiol. 2018;72(5):489.
