Conservative Management of Atrial Fibrillation in Heart Failure Patients in a Tertiary Care Medical Center

Abstract

Introduction Several recent studies support a salutary effect of atrial fibrillation (AF) ablation in patients with heart failure with reduced ejection fraction (HFrEF), with ablation reducing mortality and heart failure hospitalization compared to strategies of rate control or anti-arrhythmic medication. The current patterns of AF management in the HFrEF population in tertiary care centers are not well understood. Objective To determine the primary approach to AF treatment in patients with HFrEF in a large tertiary care center with access to all modalities of CHF and AF management. Methods Consecutive patients undergoing ICD interrogation were assessed for history of AF and HFrEF and AF management strategy. Strategies were categorized as rate control, anti-arrhythmic medication rhythm control, or curative ablation (RFA). Use of anticoagulation was also assessed along with patient co-morbidities. Results Sixty-seven patients (76% men, mean age 70) with LVEF ≤35% and AF were assessed over a six month period in ICD clinic. A strategy of rate control was pursued in 34.3%, rhythm control in 35.8%, and RFA in 28.4% (remainder were untreated). Anticoagulation was employed in 82.1%. The most commonly used antiarrhythmic medication was amiodarone and most common anticoagulant was warfarin. Conclusions These findings portray a conservative approach to AF in the HFrEF population, with fewer than 30% of patients undergoing RFA. These data suggest that further large trials with positive outcomes for RFA in HFrEF population will likely be required to overcome conflicting data and current treatment patterns of AF in this population, given the patients’ co-morbidities.