Results of a Survey “Ethacizine evaluation for acute and chronic treatment of atrial fibrillation in real practice: Ukrainian national survey (ETERNITY)”

Abstract

The aim of the study: based on a survey of physicians, the study aims to identify the real clinical practices regarding the use of class IC antiarrhythmic drugs in Ukraine, particularly ethacizine, for restoring sinus rhythm in paroxysmal and persistent forms of atrial fibrillation, employing a methodology similar to the “pill-in-the-pocket” approach.

Materials and methods. Data were analysed from 100 anonymous voluntary questionnaires. We used snowball sampling to collect the responses. Participants had the option to skip questions, and calculations were based on the number of respondents who answered each question.

Results. More than half of the respondents actively prescribe class IC antiarrhythmic drugs (AADs), with ethacizine being the most commonly prescribed (56.8 % of respondents). Notably, 61.4 % of respondents had never prescribed flecainide, 34.3 % had never prescribed propafenone, and 18.6 % had never prescribed ethacizine. The primary indication for prescribing class IC AADs was atrial fibrillation (AF) (43.3 %), followed by the combination of ventricular and supraventricular rhythm disturbances (34.4 %). Only 13.8 % of respondents initiate therapy with class IC AADs exclusively in inpatient settings, while 31.9 % primarily did so in outpatient settings with ECG monitoring. More than half of the respondents reported experience restoring sinus rhythm (SR) in AF with ethacizine using a regimen similar to “pill-in-the-pocket”; over a quarter of these cases were decisions made by patients already on ethacizine for SR maintenance. More than a quarter of respondents had experience using ethacizine for the “acute treatment” of AF in single doses higher than the standard 100 mg (125 mg – 6.8 %; 150 mg – 20.3 %). At the same time, 31.9 % of respondents prescribed ethacizine for SR restoration in AF as discrete regimens, prescribing low doses at shorter intervals (1–3 hours).

Conclusions. The survey results indicate that class IC AADs, especially ethacizine, are actively prescribed in real clinical practice not only for arrhythmia prevention, including AF, but also for SR restoration. This underscores the need for high-quality clinical studies to assess the efficacy and safety of such treatment strategies for ethacizine, which remains less studied within class IC AADs.