Experimental Nasal Spray Appears Safe, Effective at Treating Rapid Heartbeat

A fast-acting medication delivered as a nasal spray may allow patients with intermittent rapid heartbeats to treat themselves at symptom onset. A new study found that the medication, etripamil, a rapid- and short-acting investigational medication, restored normal heart rhythm in less than 30 minutes in most users. The research was published in the Journal of the American Heart Association.

“This is a potential new and exciting option for patients to safely self-treat their rapid heartbeat without direct medical supervision to avoid emergency room visits and medical interventions,” said James E. Ip, MD, lead author of the study and an associate professor of clinical medicine at Weill Cornell Medicine at New York-Presbyterian Hospital in New York City, via a press release.

Approximately 1 in 300 people in the United States experience intermittent rapid heartbeat, which is defined by more than 100 beats per minute or, more typically, 150 to 200 beats per minute. The condition, known as paroxysmal supraventricular tachycardia (PSVT), is typically treated by performing vagal maneuvers, or actions to slow the heart rate, such trying to bear down, whereby a person breathes out with their stomach muscles without letting air out of their nose or mouth. While these techniques are sometimes successful, in the 20% to 40% of cases that they were not, the patient requires immediate medical attention to return their heart rate to normal.

In this open-label study, which began in December 2018 and lasted until October 2023, 169 patients (average age, 58 years; 62% women) with PSVT self-administered at least 1 dose of etripamil at 70 mg over the study duration.

Novel Spray a Potential “Great Option”

The findings showed that etripamil restored rapid heart to normal within 30 minutes in over half (60.2%) on 188 verified PSVT episodes, and within an hour in 75.0% of confirmed episodes. Moreover, the study found that of participants who self-treated 2 episodes, over 63% responded to the medication within 30 minutes, and over half (53%) converted to normal heart rate on both episodes.

In terms of safety, 32.4% of patients reported 1 or more side effect from the medication, but most were mild to moderate. No serious heart-related adverse events were reported.

”There are no great options for patients to self-treat paroxysmal supraventricular tachycardia, and this condition can cause significant distress and anxiety,” Dr. Ip said. “Similar to an albuterol inhaler for asthma patients or an epinephrine pen for patients [who] have severe allergies or anaphylaxis, etripamil nasal spray may be a great option for people who have paroxysmal supraventricular tachycardia.”