Results of a national survey on ethacizine for atrial fibrillation treatment in real practice as a part of a patient oriented approach

Abstract

The aim of the Ethacizine Evaluation for acute and chronic treatment of atRial fibrillatioN in real practIce: Ukrainian naTional surveY (ETERNITY) was to examine the specifics of ethacizine use, Class IC antiarrhythmic drug (AAD) with additional anticholinergic properties, in the management of patients with atrial fibrillation (AF), including a "pill-in-the-pocket"-like strategy in real clinical practice as a part of doctor-patient interaction.

Methods: The survey was conducted among Ukrainian cardiologists, physicians, family doctors, and arrhythmologists from November 15, 2024, to February 28, 2025. A total of 100 completed questionnaires were analyzed. The snowball method was used to involve more respondents in the survey. Answers to questions regarding AADs were voluntary; doctors had the option to skip a question if they preferred not to answer or lacked the necessary experience.

Results: Most respondents were cardiologists (60%), most often from institutions providing outpatient care (66%). The comparison of ethacizine with two other Class IC ADDs indicates at least equal satisfaction among the respondents with this drug (Table 1). It is important to note that only 13.8% of respondents always initiate therapy with Class IC ADDs in the hospital according to existing guidelines, 22.3% initiate therapy in the hospital when possible, but sometimes on an outpatient basis, 31.9% - mainly on an outpatient basis, and 17% - entirely on an outpatient basis. Data on considering the patient's opinion when prescribing Class IC AADs are presented in Table 2.

Pharmacological cardioversion with ethacizine similar to the "pill-in-the-pocket" strategy for restoring sinus rhythm (SR) in AF was used by 52.3% of respondents, 28.3% reported that this approach was initiated by the patient who had already taken ethacizine to maintain SR. Some respondents noted the experience of prescribing higher single doses (125 mg - 6.8%, 150 mg - 20.3%) than usual one (single dose 100 mg of ethacizine for restoring SR in AF). Interestingly, 31.9% of the respondents had experience using ethacizine to restore SR in a discrete dose mode, not a single dose mode, and 60% of respondents found this strategy efficient.

Conclusions: Patients who previously received ethacizine often choose it to restore SR during paroxysmal AF. ETERNITY respondents consider patients` opinion and rate ethacizine efficacy for AF treatment at the same level as flecainide or even more positively than propafenone. So, it is advisable to plan large clinical trials to evaluate the use of ethacizine for restoring and/or maintaining SR in AF. Regarding ethacizine, it is more appropriate to use the term "pharmacological cardioversion in a single or discrete dose mode" instead of "pill-in-the-pocket" strategy, since both approaches are used in real practice.