Experimental drugs for supraventricular tachycardia: an analysis of early phase clinical trials

ABSTRACT

Introduction

Supraventricular tachycardias (SVT) are a diverse group of commonly encountered arrhythmias arising at or above the atrioventricular (AV) node. Conventional anti-arrhythmic medications are restricted by extensive side-effect profiles and limited efficacy. Catheter ablation has emerged as a first-line therapy for many arrhythmias but is not a suitable option for all patients. This has prompted the exploration of novel pharmacological approaches targeting specific molecular mechanisms of SVT.

Areas Covered

This review article aims to summarize recent advancements in pharmacological therapeutics for SVT and their clinical implications. The understanding of molecular mechanisms underlying these arrhythmias, particularly atrial fibrillation, has opened up new possibilities for targeted interventions. Beyond the manipulation of ion channels and membrane potentials, pharmacotherapy now focuses on upstream targets such as inflammation, oxidative stress, and structural remodeling. This review strives to provide a comprehensive overview of recent advancements in pharmacological therapeutics directed at the management of SVT. We begin by providing a brief summary of the mechanisms and management of commonly encountered SVT before delving into individual agents, which in turn are stratified based on their molecular treatment targets.

Expert Opinion

The evolving landscape of pharmacologic therapy offers hope for more personalized and tailored interventions in the management of SVT.

KEYWORDS:

• Supraventricular tachycardia
• atrial fibrillation
• atrial flutter
• novel therapies
• antiarrhythmics

Article highlights

• SVT forms an important facet of clinical cardiology practice. AF in particular is estimated to impact 12.1 million individuals in the United States by 2030.

• Commonly used anti-arrhythmic medications are limited in their efficacy and use is greatly limited by side effects and pro-arrhythmic concerns.

• Catheter ablations, though highly effective, are not a feasible option in every patient, and despite technological advances, remain an interventional procedure with associated risks.

• Novel SVT medications are hence an important requirement – a number of new pharmacological targets have emerged in the spotlight in recent years, and medications acting on them are under development and study. This includes RyR2, late sodium channel, TASK-1, and CaMKII inhibitors, to name a few.

• Inhaled forms of these medications including etripamil and flecainide are also the emerging options in the acute management of these patients.

• Although a number of promising options have emerged, large-scale trials are required before these pharmacological agents evolve into mainstream treatment options.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.