Rapid heartbeat: How a nasal spray may offer quick, easy treatment

• About 1 in 300 people in the United States have a racing heartbeat condition known as paroxysmal supraventricular tachycardia.
• In a new study, a nasal spray drug showed promise in treating these acute events and potentially becoming superior to current treatments.
• If deemed safe and effective, this drug could help people get immediate relief and also lower the burden on the emergency healthcare system.

Treatment for a racing heartbeat condition could soon be almost as simple as taking a fast-acting inhaler for an asthma attack if clinical trials of a new nasal spray pan out.

That’s according to new research published today in the Journal of the American Heart Association.

Paroxysmal supraventricular tachycardia (PSVT) is a term that defines a subset of heart conditions in which the heart beats for more than 100 beats per minute in its lower chambers for a short period of time.

The condition affects millions of people in the United States and is expected to affect nearly more than 7 million people by 2050, according to the National Library of Medicine.

While not typically life-threatening, the condition can cause fainting, light-headedness, shortness of breath, dizziness, and heart palpitations. It can develop at any age and stem from conditions as various as anxiety, cardiomyopathy, and pneumonia.

Looking for treatments for racing heartbeats

Finding a safe, easily self-administered frontline treatment for PSVT has long been a goal of researchers.

Current treatments usually involve either treating the root causes of PVST, such as prescribing beta blockers to treat hyperthyroidism-induced PVST and surgical or catheter treatment to eliminate disruptive heart tissue.

In less severe cases, doctors sometimes employ vagal maneuvers, which involve techniques including applying abdominal pressure, “bearing down” motions, and putting gentle pressure on the carotid artery to calm the vagus nerve.

However, self-administered vagal maneuvers are only effective 20 to 40% of the time, according to the American Heart Association, and none of these treatments is as simple as taking a quick nasal spray.

“SVT can cause the heart rate to increase very rapidly at times over 200 beats per minute. It is very uncomfortable and needs immediate medical attention,” said Dr. Babak Bozorgnia, the section chief of Cardiac Electrophysiology at the Lehigh Valley Heart and Vascular Institute in Pennsylvania who was not involved in the study.

“Traditionally, the medical treatment has been in an emergency room. This novel approach may allow patients to stop the SVT much quicker and perhaps at home,” Bozorgnia told Medical News Today.

Details from the heartbeat nasal spray study

In the new study – which involved 169 people who experienced repeated PSVT and for whom vagal maneuvers did not work – 105 were given the nasal spray drug etripamil at least once during a median of 232 days of follow-up.

Of this group, researchers reported, 60% of PSVT episodes resolved within 30 minutes, and 75% resolved within an hour.

The researchers added that while around one in three study participants reported side effects from the drug, these were mild, including nasal congestion and runny nose but no heart-related events.

Those results were also largely duplicated among the 40 participants who had to use the nasal spray twice, with 75% also responding to the medication within 30 minutes.

Out of all groups, around 23% did not respond to the medication and return to a normal heartbeat.

“This is the first long‐term follow‐up study evaluating the safety and efficacy of self‐administered etripamil 70‐mg nasal,” the study authors wrote. “Over clinically separate episodes, the safety and tolerability of repeat self‐administration of etripamil, without medical supervision, appeared to be maintained during this study.”

Experts react to the nasal spray study

While the study is a promising step forward, experts noted there is still more to be done before this drug can be deemed ready for public use – including follow-up studies and the need for eventual approval from the federal Food and Drug Administration.

“Just like any new treatment method, we need to make sure it is safe to be used by patients outside of a clinical setting,” Bozorgnia said. “Large-scale, double-blind randomized control trials with long follow-up periods are needed to confirm the findings before etripamil clinical endorsement.”

Dr. Esseim Sharma, a physician at University Hospital in Ohio and an assistant professor of medicine at the School of Medicine at Case Western Reserve University in Cleveland, agreed.

“While etripamil presents an intriguing option in managing patients with PSVT, we still have a lot to learn about the best way to use this drug,” Sharma, who was not involved in the study, told Medical News Today. “For example, in this study, only a single dose of etripamil was used, but in the RAPID trial (recently published in the Lancet in June), a second dose of etripamil was given after 10 minutes, with seemingly better efficacy. It should be also noted that the RAPID trial failed to show a significant decrease in healthcare utilization in the etripamil arm versus the placebo arm, although the trial was underpowered to assess this difference.”

Healthcare system use is an important point as nearly 50,000 Americans each year go to the emergency room for PSVT. However, this drug has the potential to shift the strain away from emergency rooms.

“If successful and, more importantly, safe, this can help reduce the number of patients that have to be treated in the Emergency Departments and shift it to outpatient office visits,” Bozorgnia explained. “It will allow patients to receive care much faster and also reduce the cost by not having to seek help at the ER, which is typically very expensive.”

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