The FDA has approved the intravenously administered beta₁-adrenergic blocker landiolol (Rapiblyk – AOP) for short-term reduction of ventricular rate in adults with supraventricular tachycardia including atrial fibrillation and atrial flutter. Esmolol (Brevibloc, and generics), another IV beta blocker, was approved earlier for the same indication.

Aficamten (Myqorzo – Cytokinetics), an oral cardiac myosin inhibitor, has been approved by the FDA to improve functional capacity and symptoms in adults with symptomatic obstructive hypertrophic cardiomyopathy (HCM). It is the second cardiac myosin inhibitor to be approved in the US for this indication; mavacamten (Camzyos) was approved in 2022.

The FDA has approved Cardamyst (Milestone), a nasal spray formulation of the nondihydropyridine calcium channel blocker etripamil, for conversion of acute symptomatic episodes of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm in adults. Cardamyst is the first product containing etripamil to be approved in the US. It is being marketed as the only FDA-approved, self-administered, rapid-acting treatment option for acute episodes of PSVT.

View the Comparison Chart: Some Drugs for HFrEF

Pharmacologic management of chronic heart failure (HF) is primarily determined by the patient's left ventricular ejection fraction (LVEF) and severity of symptoms. Patients with chronic HF who have an LVEF ≤40% are considered to have heart failure with reduced ejection fraction (HFrEF) and those with an LVEF ≥50% are considered to have heart failure with preserved ejection fraction (HFpEF). Patients with an LVEF of 41-49% have heart failure with mildly reduced or mid-range ejection fraction.

View the Comparison Table: Some Drugs for Migraine Prevention

Atogepant (Qulipta – Abbvie), an oral small-molecule calcitonin gene-related peptide (CGRP) receptor antagonist ("gepant"), has been approved by the FDA for prevention of episodic migraine in adults. It is the second oral CGRP receptor antagonist to be approved in the US for this indication; the first was rimegepant (Nurtec ODT), which is also approved for acute treatment of migraine. Parenteral CGRP monoclonal antibodies are approved for prevention of migraine (see Table 3).

The FDA has approved mavacamten (Camzyos – MyoKardia/BMS), a modulator of cardiac myosin, to improve functional capacity and symptoms in adults with New York Heart Association (NYHA) class II or III obstructive hypertrophic cardiomyopathy (HCM) who have a baseline left ventricular ejection fraction (LVEF) ≥55%. Mavacamten is the first drug in its class to become available in the US.

Indications for preventive treatment of migraine include frequent or severe attacks, contraindications to or toxicity with acute treatments, and patient preference. Drugs for acute treatment of migraine were reviewed in a previous issue.

Atrial fibrillation (AF) is the most common arrhythmia in the world. Risk factor modification, anticoagulation, rhythm control, and rate control are the four pillars of its management. American College of Cardiology/American Heart Association (ACC/AHA) guidelines on management of AF were updated recently.