1b) That #EHRA affiliation is 🔑to today's program, as we focus on #AFib with rapid ventricular response #RVR. Atrial fibrillation with RVR leads to loss of atrial kick, shortened ventricular filling time, and increased #myocardial oxygen demand. pic.twitter.com/oNAjdY4Xbm
— cardio-met (@cardiomet_CE) November 11, 2023
2b) You can earn 0.5hr 🆓 CE/#CME by following this 🧵. Statement of accreditation & faculty disclosures are at https://t.co/gvXca4G9Xm. ONLY @cardiomet_ce posts LIVE serialized #accredited #tweetorials from major society conferences!
— cardio-met (@cardiomet_CE) November 11, 2023
4) Much less robust is the literature on symptom management in pts with #paroxysmal #AFib that presents with #RVR, or patients with persistent AF who occasionally "flip" into an RVR pattern. In either case, RVR is highly symptomatic and anxiety-provoking😨 for the patient.
— cardio-met (@cardiomet_CE) November 11, 2023
5b) This combination is generally viewed as safe 🦺, with a rate of adverse events of only ~3-4%, but those #AEs are often very significant, inc unexplained syncope, symptomatic #bradycardia/#hypotension, & 1:1 atrial #flutter.
— cardio-met (@cardiomet_CE) November 11, 2023
See https://t.co/Z4i9miS0dM.
7) Rate control in established #AFib, when patients are already #anticoagulated, is desirable in and of itself for #symptom relief, while in pts with #paroxysmal #AF, on-demand slowing of the rate may ⬇️ anxiety & sympathetic drive while awaiting formal care.
— cardio-met (@cardiomet_CE) November 11, 2023
9) So now we frame-shift. Take a look at a previous LIVE #tweetorial on a symptomatic tachyarrhythmia–#PSVT, at https://t.co/mdbvT263sA (you can still earn 🆓 CE/#CME credit!). In that program you learned about a novel #nasal administered calcium channel blocker #CCB.
— cardio-met (@cardiomet_CE) November 11, 2023
11) An open label extension study of #etripamil followed #RAPID; it was called #NODE_303. After adjudication of etripamil uses in NODE-303, it turned out that 18 pts (21 events) had self-administered etripamil for #AF-RVR, not #PSVT.
— cardio-met (@cardiomet_CE) November 11, 2023
13) There was a striking ⬇️ in ventricular rate from baseline: maximum ⬇️ 27.4 ± 6.1 bpm at 22 min, and 16.2 bpm ± 5.6 at 60 min. Among tx'd patients, #etripamil was well-tolerated and there were no #SAEs. pic.twitter.com/F0eKu6Cr0t
— cardio-met (@cardiomet_CE) November 11, 2023
15) #ReVeRA_201 is a Ph2 placebo-controlled, double-blind, single-dose study of #etripamil in pts w/#AFRVR in hospital, drug administered by an #HCP. And today 11NOV2023 at #AHA23, #DrMarcoAlings of #AmphieHospital 🇳🇱, standing in for Prof Camm, presented these results. pic.twitter.com/ojfY9zpFna
— cardio-met (@cardiomet_CE) November 11, 2023
16b) #Etripamil is being developed to
— cardio-met (@cardiomet_CE) November 11, 2023
👉 satisfy unmet need for self-administered therapy that is portable & well-tolerated outside healthcare setting
👉Developed to rapidly control ventricular rate in patients with symptomatic #AFib
17) This Ph 2 study randomized 69 pts & enrolled a #safety population n=56 (all pts exposed) + #efficacy population n=49 (received study drug, remained in AF, & had ECG available for at least 60min).
— cardio-met (@cardiomet_CE) November 11, 2023
The #etripamil & #placebo cohorts were well matched. Most had #paroxysmal #AF. pic.twitter.com/qVYHHeRtMw
19) Here are the ventricular rate trends for 60 & 180min after dosing, which nicely show the early separation.
— cardio-met (@cardiomet_CE) November 11, 2023
👉Key secondary EPs were time to rate nadir, % pts reaching rate < 100, and duration of rate < 100. All supported #etripamil over placebo. pic.twitter.com/qB8gtIojog
20b) Re "rescue": additional tx w/ #rate control & #AADs was allowed to be administered 60min after study drug (and only within 60 min if deemed necessary). No patients received additional medication within the first 60 min.
— cardio-met (@cardiomet_CE) November 11, 2023
21) And then there are of course the 🔑patient-reported outcomes, #PRO, assessed in #ReVERA by the validated #TSQM_9 score
— cardio-met (@cardiomet_CE) November 11, 2023
🔓 https://t.co/Sv5eL5GFUr
👉3⃣ domains queried: #Effectiveness, Global #Satisfaction, & #Convenience
🫀 No surprise: better rate ⬇️ = better satisfaction: pic.twitter.com/6RBLQVyAKx
23) The authors summarize their results as:
— cardio-met (@cardiomet_CE) November 11, 2023
🫀 #etripamil better & faster at rate control in #AF_RVR than placebo
🫀 better/faster rate control ➡️ better #satisfaction
🫀 acceptable safety profile
🫀 further investigation warranted, including a home-use trial as done in #PSVT pic.twitter.com/1MDmssEagl
25a) So: which is FALSE about #AFib with #RVR?
— cardio-met (@cardiomet_CE) November 11, 2023
A. Rhythm control in #AF⬇️stroke risk
B. Rate control in AF ⬇️stroke risk
C. The most common 💊 used for rate control in #AF_RVR are #betablockers & #CCBs
D. Most accepted pill in the pocket tx aims for rhythm control > rate control
25c) In #ReVeRA, the average reduction in ventricular rate in #AFRVR with 👃#etripamil vs placebo at rate nadir was about how many beats?
— cardio-met (@cardiomet_CE) November 11, 2023
A. zero–they were about the same
B. 10
C. 30
D. 50
26) And that, LIVE from Philadelphia & #AHA23, catches you up on the LATEST data on new strategies–likely to be patient-actuated–to improve symptoms by #rate control in #AF_RVR. Claim your 0.5hr 🆓 CE/#CME now at https://t.co/DZmdfAuSWS, & FOLLOW @cardiomet_ce for more #MedEd!
— cardio-met (@cardiomet_CE) November 11, 2023