2023-09-27 14:20:28
by Anna Fregonara
The drug, awaiting approval from the Food and Drug Administration, would allow the heartbeat to be restored to normal in less than 30 minutes.
An experimental fast-acting nasal spray drug could allow patients suffering from a sudden acceleration of heart rate (150-200 beats per minute) to return to a normal rhythm in less than 30 minutes. These are the results of a study just published in the Journal of the American Heart Association. The drug (etripamil), a calcium channel blocker, is awaiting the green light from the Food and Drug Administration, the American body that regulates the approval of medicines. a treatment that the patient self-administers as soon as he recognizes the symptoms and which, according to researchers, can potentially help reduce hospital admissions. Overseas, about 50,000 emergency room visits per year are due to this disorder, said James E. Ip, lead author of the study and associate professor of clinical medicine at Weill Cornell Medicine at New York-Presbyterian Hospital in New York City . The therapy could, therefore, save a trip to the emergency room for approximately 1 in 300 adults in the United States who are diagnosed with this condition which, in technical terms, is called paroxysmal supraventricular tachycardia (TPSV). As the name itself reveals, this set of cardiac arrhythmias originates from the structures located above the ventricular cavities of the heart, therefore atria and atrioventricular node. Two thirds of these tachycardias arise in the latter, explains Roberto Pedretti, director of the Cardiovascular Department at the IRCSS MultiMedica in Sesto San Giovanni (Milan) and member of the Board of Directors of the European Association of Preventive Cardiology.
Research
The study began in December 2018 and ended in October 2020. Of the 169 patients enrolled with a diagnosis of rapid heartbeat (people suffering from cardiac pathologies such as atrial fibrillation were excluded from the sample), 105 self-administered at least one dose of etripamil ( 70 mg). The drug returned heart rate to normal within 30 minutes in 60% of 188 TPSV episodes, verified with a wearable device capable of measuring heart rhythm, and within an hour in 75% of episodes. Thirty-four participants (32%) reported one or more side effects from the medicine, most commonly mild to moderate nasal congestion or discomfort or a runny nose, while no major heart-related adverse events occurred. The treatment is being studied both for people suffering from atrial fibrillation and for children aged 6-17 for whom a separate study is being evaluated and should begin this year.
How to recognize it
Patients with TPSV most commonly report palpitations, dizziness or lightheadedness, and shortness of breath (dyspnea). Due to the paroxysmal nature of the arrhythmia, the onset and cessation of symptoms are usually sudden. If this tachycardia is characterized by a faster than normal rhythm, atrial fibrillation is differentiated by the irregularity of the beats, continues the cardiologist. People with significant heart disease may have additional symptoms such as severe shortness of breath and chest pain. Some feel the need to urinate excessively, experiencing copious diuresis during or after the tachycardic event. The risks for those suffering from TPSV are more represented by the impact on the quality of life, particularly in the case of frequent episodes, than by a bad prognosis. In fact, a disorder generally well tolerated in the majority of patients.
Special “exercises”
There are numerous treatments both to stop the arrhythmia and to prevent relapses with pharmacological therapy or ablation, a moderately invasive intervention. The standard treatment that a patient can administer to himself during an episode of TPSV to turn off or modulate the arrhythmia, however, consists of the so-called vagal maneuvers, special “exercises” that stimulate the vagus nerve and therefore reduce the heart rate”, concludes Pedretti. “One of these maneuvers consists of trying to lower yourself, exhaling against resistance without letting the air out of your nose or mouth, contracting your abdominal muscles. If self-administered vagal maneuvers are not effective, which happens about 20 to 40 percent of the time, the person must go to the emergency room to get immediate treatment with intravenous drugs to return the heart rate to normal.
September 27, 2023 (changed September 27, 2023 | 2.20pm)
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