CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 22 AFRICA 27. Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). J Am Med Assoc Cardiol 2020; 5(7): 819–824. 28. Atri D, Siddiqi HK, Lang JP, Nauffal V, Morrow DA, Bohula EA. COVID-19 for the cardiologist: basic virology, epidemiology, cardiac manifestations, and potential therapeutic strategies. J Am Coll Cardiol Basic Transl Sci 2020; 5(5): 518–536. 29. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. J Am Med Assoc 2020; 323(16): 1612–1614. 30. Salah HM, Mehta JL. Takotsubo cardiomyopathy and COVID-19 infection. Eur Heart J Cardiovasc Imaging 2020; 21(11): 1299–1300. 31. Roca E, Lombardi C, Campana M, Vivaldi O, Bigni B, Bertozzi B, et al. Takotsubo syndrome associated with COVID-19. Eur J Case Rep Intern Med 2020; 7(5): 001665. 32. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). J Am Med Assoc Cardiol 2020; 5(7): 811–818. Erratum in: J Am Med Assoc Cardiol 2020; 5(7): 848. 33. Shi Z, Fu W. Diagnosis and treatment recommendation for novel coronavirus pneumonia related isolated distal deep vein thrombosis. Shanghai Med J 2020; 43(4): 207–210. 34. Han H, Yang L, Liu R, Liu F, Wu KL, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med 2020; 58(7): 1116–1120. Home use tachycardia nasal spray shortens episodes: randomised US trial No medications are currently approved for acute termination of paroxysmal supraventricular tachycardia without medical supervision, but results of a recent trial show that a selfadministered, ‘at home’ nasal spray, can dramatically reduce patients’ tachycardia episodes. An analysis of the phase III randomised RAPID trial showed that the investigational L-type calcium channel blocker etripamil self-administered nasal spray shortened spontaneous paroxysmal supraventricular tachycardia episodes among patients in at-home settings to sinus rhythm within 30 minutes. ‘Patients know they are having supraventricular tachycardia when these episodes occur,’ said Dr Jayne Morgan of Piedmont Healthcare in Atlanta. ‘Generally, these episodes are very worrisome and will drive patients to seek medical care.’ Aside from symptoms, reports MedPage Today, supraventricular tachycardia can also increase risks of blood clotting and downstream strokes. The probability of the primary endpoint of the study – conversion of adjudicated paroxysmal supraventricular tachycardia to sinus rhythm within 30 minutes – was 64.3% with etripamil, which had the option of repeat dosing, compared with 31.2% with placebo (HR 2.62, 95% CI 1.66–4.15, p < 0.001), reported Dr James Ip of Weill Cornell Medical Centre in New York City, during the recent American Heart Association annual meeting (5–7 November). At 90 minutes, 80.6% of the patients who self-administered etripamil converted to sinus rhythm compared with 60.7% of placebo patients (HR 1.93, 95% CI 1.35–2.75, p < 0.001), which was maintained through the five-hour observation period (82.7 vs 72%). Median time to convert to sinus rhythm was 17.2 minutes with etripamil compared with 53.5 minutes with placebo, Ip noted. In a pre-specified pooled analysis, additional rescue medical interventions were less frequent with etripamil versus placebo (14.6 vs 25.4%, respectively, p = 0.013). ‘These results demonstrate a potential management strategy to self-treat episodes of paroxysmal supraventricular tachycardia with etripamil in a medically unsupervised setting,’ Ip said. RAPID’s results reverse the negative 2020 findings from the phase III NODE-301 trial, which tested self-administered etripamil in a similar patient population. That trial, which did not allow for repeat dosing, failed to show a significant benefit for the primary endpoint of conversion over five hours compared with placebo. ‘This is an extraordinary, ground-breaking study showing the effectiveness of a new drug for home acute treatment,’ said Dr Julia Indik, PhD, of the University of Arizona College of Medicine in Tuscon. ‘The number of patients to treat to avoid one emergency room treatment with etripamil is 13.’ She said what was missing from the study was a costeffectiveness analysis, which will be needed if the drug is approved. It is also unclear how guideline writers will approach the concept of self-administration of this agent, she added. The double-blind RAPID trial was conducted across 150 sites in the US, Europe and Canada; 255 patients with a history of documented sustained paroxysmal supraventricular tachycardia episodes that lasted at least 20 minutes were randomised to either etripamil (n = 135) or placebo (n = 120). Mean patient age was about 54 years, 71% were women, and nearly all were white. Patients had experienced episodes of paroxysmal supraventricular tachycardia for about two years before entering the trial. Treatment consisted of a 70-mg dose of etripamil followed by a second dose after 10 minutes if symptoms persisted, Ip explained. Patients who perceived they were having an episode applied an ECG monitor and performed a previously trained vagal manoeuvre. The study was designed to determine results after 180 events were recorded. As for safety, 50.4% of patients treated with etripamil experienced treatment-emergent adverse events that were mostly mild to moderate and transient, with the most frequent being nasal discomfort (23%), nasal congestion (12.6%) and rhinorrhoea (8.9%). No serious cardiac adverse events were observed within 24 hours of etripamil self-administration. Source: MedicalBrief 2022
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