Document Type
Article
Publication Date
5-31-2025
Abstract
BACKGROUND: There is limited knowledge of physicians' antiarrhythmic drug (AAD) treatment practices for patients with atrial fibrillation and adherence to guidelines in European countries.
METHODS: An online survey (n = 321) of cardiologists, cardiac electrophysiologists and interventional electrophysiologists was conducted in Germany (DE; n = 83), Italy (IT; n = 95), Sweden (SE; n = 60) and the United Kingdom (UK; n = 83) including 96 questions on treatment practices.
RESULTS: ESC guidelines were the most important non-patient factor influencing treatment practice (55-72 %). However, while amiodarone was frequently (88-93 %) used in heart failure with reduced left ventricular ejection fraction, it was also a typical treatment choice for minimal/no-structural heart disease (SHD) (28 %), particularly in UK. Other deviations from guidelines were the use of class 1C drugs in coronary artery disease (CAD) and other SHD, and use of sotalol in left ventricular hypertrophy and renal impairment. In-hospital initiation of sotalol was low, with the exception of SE. Sotalol (16-41 %) and dronedarone use (10-54 %) in CAD varied among countries. For frequent, symptomatic paroxysmal AF, ablation was generally favoured, but AADs were preferred by 53 % in SE. In asymptomatic or subclinical AF, AADs were used by 41 % (range: 22-60 %), ablation by 11 % (range 2-18 %). In contrast to guidelines that prioritize safety, anticipated efficacy was more important (51 %) than safety (31 %) when selecting AADs.
CONCLUSIONS: Despite recognizing the importance of guidelines, deviations in AAD use were common with the potential to compromise patient safety. These findings indicate the need for more educational support for optimal AAD selection in AF management.
Recommended Citation
Fengsrud, Espen; Blomström-Lundqvist, Carina; Camm, A. John; Goette, Andreas; Kowey, Peter R.; Merino, Jose L.; Piccini, Jonathan P.; Saksena, Sanjeev; Reiffel, James A.; and Boriani, Giuseppe, "Antiarrhythmic Drug Use in Atrial Fibrillation Among Different European Countries – As Determined by a Physician Survey" (2025). Department of Medicine Faculty Papers. Paper 493.
https://jdc.jefferson.edu/medfp/493
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
40521049
Language
English
Comments
This article is the author's final published version in IJC Heart and Vasculature, Volume 59, 2025, Article number 101709.
The published version is available at https://doi.org/10.1016/j.ijcha.2025.101709.
Copyright © 2025 The Author(s)