Fast-acting nasal spray may relieve rapid heartbeat.

Fast-acting nasal spray may relieve rapid heartbeat.

Nasal Spray to Rapidly Slow Down Heart Rate: A Game Changer for PSVT Treatment

Nasal Spray

Up to 2 million people in the U.S. experience rapid-fire heartbeats known as paroxysmal supraventricular tachycardia (PSVT). Many of them end up in the hospital for treatment. However, there is promising news for individuals with PSVT – an investigational nasal spray may soon provide a safe and quick way for patients to slow down their heart rates on their own.

Dr. James Ip, an associate professor of clinical medicine at Weill Cornell Medical Center, states that currently, PSVT is treated with intravenous medication administered in the emergency room or by paramedics when vagal maneuvers, physical actions such as bearing down, are not effective. This poses a problem, as the majority of cases require medical intervention. However, the introduction of a nasal spray called etripamil could change the game.

Medicine

Etripamil is a calcium channel blocker that, when self-administered as a nasal spray, can slow down the heart rate within 30 minutes. This finding is based on a clinical trial funded by Milestone Pharma, the maker of the drug. Presently, there are no medications approved for the self-treatment of PSVT without medical supervision.

Speaking about the potential impact of this new treatment option, Dr. Ip stated, “This is a game changer because patients can now treat their own PSVT episode by themselves and avoid calling an ambulance or going to the emergency room.”

The study, published in the Journal of the American Heart Association, involved participants who self-administered the nasal spray after experiencing PSVT episodes. The average age of the participants was 58, and they had experienced an average of 9.7 PSVT episodes in the previous year. The efficacy of the nasal spray was assessed using an electrocardiogram (ECG) patch linked to a cellphone to transmit data about the symptoms.

Of the 169 participants, 105 self-administered at least one dose of etripamil over seven months. The results showed that within 30 minutes, the nasal spray restored the heart rate to normal in 60% of the 188 PSVT episodes. Within an hour, the heart rate returned to normal in 75% of the episodes. Additionally, the study found that 63% of participants responded to the medication within 30 minutes when treating two PSVT episodes.

Furthermore, the participants displayed a high level of awareness regarding their rapid heart rhythms, with 92 individuals having one or more episodes confirmed by their ECG patch. The safety profile of the nasal spray was also promising, with no serious heart-related adverse effects reported. The most common side effects were nasal congestion or a runny nose.

Compared to oral medications, which take longer to work and may have safety concerns such as fainting and low blood pressure, etripamil offers a more convenient and accessible treatment option. The drug is also being studied for use in individuals with atrial fibrillation (a-fib), a common heart rhythm disorder, and in children aged 6 to 17.

Experts in the field of cardiology welcome the potential approval of this nasal spray, as it could revolutionize the treatment of PSVT. Dr. Deepak Bhatt, director of Mount Sinai Heart and professor of cardiovascular medicine at the Icahn School of Medicine, believes that this new treatment “could be a very effective and safe way for patients to treat themselves for this bothersome condition.”

Dr. Javier Banchs, director of electrophysiology and pacing at Baylor Scott & White Health, notes that current treatment options for PSVT are not always ideal. While catheter ablation is highly effective, it is not suitable for everyone. Vagal maneuvers, such as straining or drinking ice-cold water, also do not always work. As a result, the availability of a safe and self-administered nasal spray like etripamil is considered a breakthrough in PSVT treatment.

The manufacturer of the nasal spray, Milestone Pharma, plans to submit a new drug application to the U.S. Food and Drug Administration in October. If approved, this game-changing treatment could provide relief and peace of mind for millions of individuals experiencing rapid heartbeats.

For more information about paroxysmal supraventricular tachycardia (PSVT), visit the official website of the U.S. National Library of Medicine.

Sources: – James Ip, MD, associate professor, clinical medicine, Weill Cornell Medical Center, New York City – Deepak Bhatt, MD, MPH, director, Mount Sinai Heart, professor, cardiovascular medicine, Icahn School of Medicine, New York City – Javier Banchs, MD, director, electrophysiology and pacing, Baylor Scott & White Health, Dallas – Adam Shapira, MD, cardiac electrophysiologist, Baylor Scott & White Health – Journal of the American Heart Association, Sept. 27, 2023