Background

Paroxysmal supraventricular tachycardia (PSVT) treatment requires medically supervised intervention. Etripamil is a novel short-acting calcium channel blocker. Its intranasal spray formulation has a rapid onset of action and shows promise for the unsupervised treatment of PSVT.

Objective

We aimed to evaluate the efficacy and safety of etripamil nasal spray for the acute conversion of PSVT.

Methods

A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching the PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane databases through to 1 December 2022. RevMan version 5.4 software was used to pool dichotomous outcomes using risk ratio (RR) presented with the corresponding confidence interval (CI).

Results

Three RCTs with a total of 496 participants were included in our analysis. Etripamil was effective for PSVT conversion at 15 min (RR 1.84, 95% CI 1.37–2.48), 30 min (RR 1.86, 95% CI 1.42–2.44), and 60 min (RR 1.25, 95% CI 1.05–1.50) after drug administration; decreasing medical intervention-seeking (RR 0.58, 95% CI 0.37–0.90); and decreasing emergency room (ER) visits (RR 0.61, 95% CI 0.38–0.97). However, there was no difference at 300 min (RR 1.10, 95% CI 0.97–1.25) and it was associated with higher rates of adverse events (RR 3.17, 95% CI 2.15–4.69).

Conclusion

Etripamil nasal spray was effective and well tolerated to induce PSVT termination for up to 60 min. Therefore, etripamil nasal spray constitutes a promising strategy for PSVT self-termination without medical supervision; however, further RCTs are required before endorsement in clinical practice.

中文翻译：

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依曲帕米鼻喷雾剂治疗急性阵发性室上性心动过速的有效性和安全性：随机对照试验的系统回顾和荟萃分析

背景

阵发性室上性心动过速 (PSVT) 的治疗需要医疗监督干预。Etripamil 是一种新型短效钙通道阻滞剂。其鼻内喷雾剂起效迅速，有望用于无人监督的 PSVT 治疗。

客观的

我们的目的是评估依曲帕米鼻喷雾剂治疗 PSVT 急性转化的有效性和安全性。

方法

综合随机对照试验 (RCT) 的系统回顾和荟萃分析，这些试验是通过系统搜索 PubMed、EMBASE、Web of Science、SCOPUS 和 Cochrane 数据库检索到的，截至 2022 年 12 月 1 日。使用 RevMan 5.4 版软件来汇总二分法使用风险比（RR）和相应的置信区间（CI）呈现的结果。

结果

我们的分析中纳入了三项随机对照试验，共有 496 名参与者。依曲帕米在术后 15 分钟（RR 1.84，95% CI 1.37–2.48）、30 分钟（RR 1.86，95% CI 1.42–2.44）和 60 分钟（RR 1.25，95% CI 1.05–1.50）时对 PSVT 转换有效。药物管理; 减少寻求医疗干预（RR 0.58，95% CI 0.37–0.90）；急诊 (ER) 就诊次数减少（RR 0.61，95% CI 0.38–0.97）。然而，300 分钟时没有差异（RR 1.10，95% CI 0.97–1.25），并且与较高的不良事件发生率相关（RR 3.17，95% CI 2.15–4.69）。

结论

依曲帕米鼻喷雾剂可有效且耐受性良好，可诱导 PSVT 终止长达 60 分钟。因此，依曲帕米鼻喷雾剂是一种在没有医疗监督的情况下自行终止 PSVT 的有前途的策略；然而，在临床实践认可之前还需要进一步的随机对照试验。