Key result
Supplemental questionnaire outlines a physician survey on AAD use in AF with no clinical results.
Why the study?
There was limited knowledge regarding physicians' antiarrhythmic drug treatment practices for atrial fibrillation and guideline adherence across European countries.
Cross-Sectional
Physicians frequently deviate from ESC guidelines when prescribing antiarrhythmic drugs for atrial fibrillation, prioritizing anticipated efficacy over safety.
Survey data show frequent ESC guideline deviations in AF AAD prescribing with efficacy prioritized; leaves open need for outcome studies before practice change.
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.
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Fengsrud et al. (2025) conducted a cross-sectional in Atrial fibrillation. Antiarrhythmic drugs was evaluated. The provided text is a supplemental questionnaire for a physician survey on antiarrhythmic drug use in atrial fibrillation and contains no clinical results.
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