M.V. Hrebenyk, S.М. Masliy Clinical experience of pharmacotherapy of arrhythmias: focus on ethacizine – effectiveness and safety profile

The aim – to evaluate the place of ethacysin in the contemporary treatment of arrhythmias by means of retrospective analysis of 30 years experience in the treatment of heart rhythm disorders in a cohort of cardiorheumatology patients, including comorbidity with diabetes mellitus and chronic obstructive pulmonary disease; to investigate catamnesis and survival of these patients for 15 years.

Material and methods. A 30 years’ experience of treatment of extrasystoles and paroxysmal / persistent atrial fibrillation (AF) with ethacizine in 74 patients without significant structural heart disease has been analyzed retrospectively. Maximal duration of continuous therapy was 12 years, maximal duration of intermittent therapy was 20 years. In different periods, ECG, Holter ECG monitoring, echocardiography, heart rate variability analysis, dispersion of repolarization, late ventricular potentials, exercise stress testing, pharmacological tests were used along taking into account underlying condition and monitoring of treatment effectiveness.

Results. The use of ethacizine was effective in 71.3 % of patients, including AF interruption – in 61.7 %, ventricular ectopy control – in 78.9 %, maintenance of sinus rhythm in patients with paroxysmal AF – in 58.4 % cases. Therapy was more effective in vagus-mediated AF in which the use of antiarrhythmic agents is limited. No serious adverse events were registered throughout the whole period of observation, indicating at acceptable ethacizine safety profile. Most of adverse reactions were predictable (22.7 %) and described in the medication insert. These were related to the antiarrhythmic effect and might be classified into 3 categories: 1) general, extracardiac (4.5–9.1 %); 2) associated with electrophysiological effect upon myocardium (18.1 %), considered to be within the normal limits; 3) occasional cases (right bundle branch block, Brugada type 1 ECG pattern, asymptomatic episode of ventricular tachycardia), leading to the discontinuation of the drug.

Conclusions. Overall, ethacizine was effective and safe even for the long-term use provided the patients are selected properly (those without significant structural heart disease) and the recommended algorithm of use and control is followed.

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