Atrial Fibrillation Management in Heart Failure: Interrupting the Vicious Cycle

Abstract

In this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure. While rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outcomes in patients with coexisting heart failure. Atrial fibrillation is the most common arrhythmia that frequently coexists with heart failure. The incidence of one condition increases in the presence of the other posing a significant treatment challenge. Despite ample advancement in management strategies of atrial fibrillation and heart failure, this combination is associated with higher morbidity and mortality when found in the same patient. The treatment goal in these patients is to improve quality of life by controlling symptoms and to prevent thromboembolism with appropriate anticoagulation. Catheter ablation is a promising treatment option for symptomatic patients with depressed ventricular function. Finally, pacing with cardiac resynchronization therapy after AV nodal ablation should be considered when strict control of ventricular rate is desired in atrial fibrillation patients who meet the criteria for device implantation.