Atrial Fibrillation Ablation in Heart Failure Patients.

Michael Derndorfer,Shaojie Chen,Helmut Pürerfellner

doi:10.3390/jcm10163512

Abstract

Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome.

Highlights

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with rapidly increasing numbers worldwide due to the progressive aging of the population. It is predisposed by several risk factors such as heart failure (HF), ischemic heart disease, high blood pressure, valvular heart disease, sleep apnea, and diabetes, and at the same time increases the risk of developing heart failure of any kind
Concerning medical treatment strategies for heart rate control in patients with reduced left ventricular ejection fraction (LVEF), beta blockers and/or digoxin are recommended to target a heart rate
Similar results were reported in the Atrial Fibrillation (AF)-congestive heart failure (CHF) [15] trial (2008), a multicenter randomized study comparing the maintenance of sinus rhythm with control of the ventricular rate in patients with Heart Failure (HF) symptoms, LVEF

Summary

Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia, with rapidly increasing numbers worldwide due to the progressive aging of the population. It is predisposed by several risk factors such as heart failure (HF), ischemic heart disease, high blood pressure, valvular heart disease, sleep apnea, and diabetes, and at the same time increases the risk of developing heart failure of any kind (heart failure with preserved ejection fraction, HFpEF; heart failure with mid-range ejection fraction, HFmrEF; heart failure with reduced ejection fraction, HFrEF). Fibrillation Begets Heart Failure and Vice Versa” [2]) When both conditions occur in the same patient, the prognosis is worse than with either condition alone [3].

Pathophysiologic and Cellular Mechanisms

Scientific Evidence Concerning AF Ablation in HF Patients

Recommendations on AF Treatment in HF Patients

Findings

Conclusions