The Efficacy and Safety of Etripamil Nasal Spray for Acute Paroxysmal Supraventricular Tachycardia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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. [ABSTRACT FROM AUTHOR]