Atrial fibrillation ablation in systolic heart failure patients: a promising tool?

Abstract

Atrial fibrillation (AF) is a significant factor complicating heart failure (HF). It is estimated that the prevalence of AF is as high as 50% of patients with NYHA class IV. The loss of atrial contribution to ventricular filling, non-physiological fast and irregular heart rate, and increased risk of thrombo-embolism are some of the adverse effects of AF in HF patients. Whether AF has an impact on survival in chronic HF patients is still a matter of debate. In the recently published AF-CHF trial, no difference was found in cardiovascular mortality between the two treatment strategies.1 Although antiarrhythmic therapy is currently considered the first-line therapy in AF patients, a recurrence of AF is a common event, with rates as high as 44–67% within 1 year after successful cardioversion.2 To date, antiarrhythmic drug therapy appears ineffective as a single strategy to maintain sinus rhythm (SR). Post hoc analyses have demonstrated that patients who remained in SR had better survival rates in both the AF-CHF and AFFIRM trials.3 There is evidence suggesting that patients with HF and AF have a worse prognosis than patients with HF and SR.4 The presence of HF has been identified as one of the … *Corresponding author. Tel: +49 9561 226348, Fax: +49 9561 226349, Email: brachmann.laptop{at}extern.klinikum-coburg.de