1b) Our faculty are esteemed 🇬🇧 cardiologist John Camm @johncamm, #EiC @Clin_Cardiology, Past President #EHRA, along with #emergencymedicine specialist Charles Pollack @md_pollack from @UMMCnews. pic.twitter.com/nh8uMOS9em
— cardio-met (@cardiomet_CE) June 28, 2023
3) In our last program on paroxysmal supraventricular tachycardia #PSVT we discussed pathophysiology, classification, and current treatment options–namely, #adenosine, #CCBs, and #betablockers. All left a bit to be desired, including the most commonly used tx.
— cardio-met (@cardiomet_CE) June 28, 2023
5a) Side effects include lightheadedness, drowsiness, flushing, dyspnea, & chest pain. This is sometimes vividly described as a "sense of doom." pic.twitter.com/2zvWNfSOLY
— cardio-met (@cardiomet_CE) June 28, 2023
6) Dyspnea after #adenosine dosing (actually contraindicated in #asthmatics) has been thought to be due to combination of #bronchoscontriction & peripheral chemoreceptor or pulmonary receptor activation.
— cardio-met (@cardiomet_CE) June 28, 2023
See 🔓 https://t.co/VXdEaBVGap
8a) In https://t.co/NnlRcScgtU we talked drugs in development as an alternative to #adenosine for breaking acute #PSVT. The most recent data are on #etripamil, a novel intra-nasal 👃#CCB verapamil analogue. pic.twitter.com/xT4jnOs8nm
— cardio-met (@cardiomet_CE) June 28, 2023
9) Ph 2 data 🔓https://t.co/jrEvqeVbyt indicated that #etripamil was safe & effective during electrophysiological testing in patients with previously documented #SVT who were induced into SVT prior to undergoing a catheter #ablation.
— cardio-met (@cardiomet_CE) June 28, 2023
10b) After a medically supervised etripamil test dose while in sinus rhythm, pts randomized 2:1 to etripamil 70 mg or placebo. When #PSVT symptoms developed, pts applied a cardiac monitor & attempted vagal maneuver; if symptoms persisted, they self-administered blinded treatment pic.twitter.com/f8NuiyjgPx
— cardio-met (@cardiomet_CE) June 28, 2023
11b) Earlier than 5hr, tho, positive effects at prespecified timepoints (3,5,10,20, 30min) were seen, eg at 30 minutes, 53.7% of #SVT conversion in the treatment arm compared to 34.7% in the placebo arm (hazard ratio, 1.87 [95% CI, 1.09-3.22]; P=0.02). pic.twitter.com/jaF8lUshhO
— cardio-met (@cardiomet_CE) June 28, 2023
12b) They pointed out the early treatment effect that persisted through 30 to ~60 minutes compared with placebo and opined that evaluating efficacy at a different ⏲️ + with a different dosing regimen for #etripamil might improve outcomes.
— cardio-met (@cardiomet_CE) June 28, 2023
14) So like #NODE_301, #RAPID enrolled pts, also outside the medically supervised setting, with acute #PSVT for self-administered 👃#etripamil 70mg but with a 2nd dose allowed if sx persist, vs placebo, & this time w/ primary endpoint being conversion to #SR at 3⃣0⃣ minutes. pic.twitter.com/3ElWPKbI0T
— cardio-met (@cardiomet_CE) June 28, 2023
15b) For the efficacy population, mean age was 54 (SD 12) & 71% were ♀️, as #PSVT occurs ♀️ > ♂️. Avg number of PSVT episodes/yr & concomitant 💊acting on #AV node were similar between groups.
— cardio-met (@cardiomet_CE) June 28, 2023
16) This time, still no difference (vs #NODE_301) in safety, but the #efficacy endpoint was positive: Conversion of adjudicated #PSVT to sinus rhythm: 64.3% at 30min, 73.5% at 60min
— cardio-met (@cardiomet_CE) June 28, 2023
Overall median time to conversion, 17.2min in #etripamil arm vs 53.5min in placebo arm pic.twitter.com/VQU7KjUPUC
17b) You learned in https://t.co/NnlRcScgtU about the adverse cost-of-care implications of #PSVT. How might self-administered patient care for abortive therapy impact that, especially w/potential avoidance of 🚑 +/- 🏥 vs #adenosine, #CCBs, or #BBs, all of which must be given 💉? pic.twitter.com/KoiueZPQqW
— cardio-met (@cardiomet_CE) June 28, 2023
18) The authors' conclusions from the primary analysis of #RAPID: pic.twitter.com/O22GJ0rKNY
— cardio-met (@cardiomet_CE) June 28, 2023
19b) In general, use of antiarrhythmic drugs for acute #PSVT is not usually recommended, in part due to a risk of #proarrhythmia with antiarrhythmic drugs #AADs. See 🔓 https://t.co/zDco8zvm0r.
— cardio-met (@cardiomet_CE) June 28, 2023
Time will tell whether a brief patient-actuated approach may be studied.
20b) Etripamil might be useful for rapid rate control in acute onset AF and for rate control protection for pill in the pocket or inhaled flecainide treatment of acute AF
— cardio-met (@cardiomet_CE) June 28, 2023
21b) #Etripamil is an investigational #CCB that can be self-administered via the nasal route.
— cardio-met (@cardiomet_CE) June 28, 2023
What is the primary disadvantage of an #AAD as an abortive therapy for #PSVT?
a. slow effect
b. nephrotoxicity
c. a & b
d. proarrhythmia
22) And that's it! You just earned 0.5hr 🆓CE/#CME! Claim your certificate at https://t.co/mdbvT263sA. Professors John Camm @johncamm & Charles Pollack @md_pollack thank you for joining us, and invite you to FOLLOW @cardiomet_ce for more of the best in #cardiometabolic #MedEd!
— cardio-met (@cardiomet_CE) June 28, 2023