Research Insights

New simple intranasal drug treatment for SVT

Supraventricular tachycardia (SVT) is a condition marked by rapid heart rates originating in the upper heart chambers known as the atria. Spanning across all age groups, SVT triggers palpitations, breathlessness, and a fluttering sensation in the chest. A recent study, published in the Lancet medical journal, called the RAPID trial, heralds encouraging strides in the realm of SVT management, showcasing the potential of a self-administered intranasal medication called etripamil for rapidly converting SVT to a normal heart rhythm in the community, outside the healthcare setting at the time of onset of this condition [1].

Understanding SVT

Supraventricular Tachycardia (SVT) entails rapid bursts of heartbeats stemming from the atria, leading to abnormally accelerated rates – often exceeding the typical resting heart rate. This sparks palpitations, chest flutters, shortness of breath, and occasional mild dizziness. SVT’s origin lies in irregular electrical pathways or circuits within the heart, spurring swift impulses that unsettle the heart’s rhythm. While SVT is generally non-life-threatening, it’s disconcerting and inconvenient for those grappling with it. SVT episodes can be brief or protracted, varying from seconds to minutes or more.


SVT’s triggers and root causes are multifaceted. Activities, emotions, and stimuli like caffeine or stress may set it off. Others might experience SVT due to underlying heart issues or structural anomalies in the heart’s electrical system. Seeking medical evaluation when SVT symptoms arise is crucial. Healthcare providers diagnose SVT via tests like electrocardiograms (ECGs) and Holter monitors. SVT management encompasses an array of approaches, including lifestyle adjustments, medications, or invasive procedures like catheter ablation or cardioversion – contingent on episode frequency and severity.


New simple intranasal drug treatment for SVT Heart Matters


Managing Acute SVT Attacks

When SVT thrusts heart rates at very fast rates, frequently more than 150 bpm during acute attacks, the conventional response entails seeking prompt medical care if the heart doesn’t naturally revert to a normal rhythm post-techniques like the Valsalva maneuver (bearing down while holding your breath, stimulating the vagus nerve to restore rhythm). In ambulances or emergency departments, adenosine – a swift-acting intravenous medication – assumes center stage, aiding heart rate normalization. If unsuccessful, controlled electric shocks or cardioversion might be considered to reset the rhythm.

New simple intranasal drug treatment for SVT Heart Matters

In some cases when the heart rate is not slowing down, it may be necessary to perform an emergency procedure known as a cardioversion. It involves delivering a controlled electric shock to the heart, typically under anesthesia, to reset its rhythm and allow it to resume beating in a coordinated and regular pattern.


New Study Unveils Promise

The RAPID Study: RAPID, a multicenter trial across 160 North American and European sites, assessed etripamil nasal spray’s safety and efficacy for paroxysmal supraventricular tachycardia (PSVT) treatment [1b]. Etripamil outperformed the placebo in swiftly converting PSVT cases to a normal heart rhythm. Etripamil users noted better heart rhythm improvement compared to placebo users. Etripamil’s effectiveness surfaced within 30 minutes and sustained for up to 300 minutes – even outside healthcare settings within the community. Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for on-demand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. The investigators aimed to evaluate the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of SVT to normal regular sinus rhythm within 30 min.

Optional Repeat-Dose Approach: The study also explored an optional-repeat-dose approach, where patients could administer a second dose of etripamil if their symptoms persisted. This approach further enhanced the efficacy of etripamil in converting PSVT to a normal heart rhythm [2]. This finding suggests that patients have the potential to manage their own PSVT episodes with self-administered etripamil, reducing the need for additional medical interventions.

Self-Administered Etripamil’s Advantages: Self-administered etripamil grants patients command over their PSVT episodes. With the nasal spray at hand, symptom management becomes swift and convenient at episode onset. 


New simple intranasal drug treatment for SVT Heart Matters

SVT is characterized by a very fast (often > 150bpm) heart rate that is regular. The electrocardiogram has a characteristic pattern that can be quickly identified and allows prompt treatment to be provided


Deeper Dive into Etripamil

Etripamil, a calcium channel blocker, caters to rapid treatment for specific heart rhythm disorders, chiefly PSVT. Administered intranasally, the nose spray ensures swift absorption and rapid action. Blocking heart calcium channels regulates electrical signals that control heartbeat, aiding the return to normal rhythm during PSVT. Etripamil’s on-demand use targets PSVT episodes, averting invasive interventions during acute care.

The RAPID study illuminates etripamil’s efficacy and safety for PSVT treatment. It underscores etripamil’s potential in converting PSVT to normal rhythm, empowering patients to manage their episodes. As research advances, etripamil holds promise as a valuable clinical treatment, lightening the PSVT healthcare burden. Etripamil is emblematic of medical progress, offering innovative solutions that grant patients control and convenience in addressing medical needs. Stay tuned for more updates in this evolving landscape.




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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.