Atrial Fibrillation Ablation for Patients with Heart Failure

Abstract

Atrial fibrillation (AF) and heart failure (HF) are common prevalent cardiovascular diseases in the world; the two diseases are often concomitant and mutually beget each other[1-2]. AF can promote the development or progression of HF, and vice versa. Actually, AF may be the most common cause of tachycardia-induced cardiomyopathy in adults, which is greatly underestimated during clinical work[3]. Guidelines recommend catheter ablation as the first-line therapy after considering the patient's choice if a patient has AF and HF with reduced ejection fraction. Recent evidence suggests that ablation procedure may improve the quality of life, life expectancy, and prognosis. However, when a patient concomitantly has AF and HF, it is a little complicated even for a cardiologist in terms of rational catheter ablation. The following aspects may favor catheter ablation[1]: 1) the patient has symptoms related to AF or even HF; 2) the patient has reduced ejection fraction; 3) the patient has no ischemic or structural heart disease, and otherwise, those two kinds of diseases can be properly cured with planned procedures in acceptable short term; 4) the patient's average heart rate is relatively rapid, especially the status still persists when HF-related symptoms have been relieved after anti-HF therapy such as diuretics and digitalis; 5) the patient is intolerant of medical therapy, or unwilling to take anti-arrhythmic drugs, or cannot gain satisfactory rate control; 6) the patient's symptoms are significantly resolved or improved even after attempting cardioversion and anti-HF therapy to improve cardiac remodeling.[4]. Atrial fibrillation (AF) and heart failure (HF) are common prevalent cardiovascular diseases in the world; the two diseases are often concomitant and mutually beget each other[1-2]. AF can promote the development or progression of HF, and vice versa. Actually, AF may be the most common cause of tachycardia-induced cardiomyopathy in adults, which is greatly underestimated during clinical work[3]. Guidelines recommend catheter ablation as the first-line therapy after considering the patient's choice if a patient has AF and HF with reduced ejection fraction. Recent evidence suggests that ablation procedure may improve the quality of life, life expectancy, and prognosis. However, when a patient concomitantly has AF and HF, it is a little complicated even for a cardiologist in terms of rational catheter ablation. The following aspects may favor catheter ablation[1]: 1) the patient has symptoms related to AF or even HF; 2) the patient has reduced ejection fraction; 3) the patient has no ischemic or structural heart disease, and otherwise, those two kinds of diseases can be properly cured with planned procedures in acceptable short term; 4) the patient's average heart rate is relatively rapid, especially the status still persists when HF-related symptoms have been relieved after anti-HF therapy such as diuretics and digitalis; 5) the patient is intolerant of medical therapy, or unwilling to take anti-arrhythmic drugs, or cannot gain satisfactory rate control; 6) the patient's symptoms are significantly resolved or improved even after attempting cardioversion and anti-HF therapy to improve cardiac remodeling.[4].