Pharmacological Treatment of Atrial Fibrillation in Patients with Heart Failure

Abstract

Atrial fibrillation (AF) frequently occurs in patients with heart failure. It is recognized that AF leads to clinical deterioration and results in worsening heart failure. AF also increases the risk of mortality and morbidity in patients with heart failure. ESC guideline 2010 introduces treatment recommendations for the management of AF in patients with heart failure. 1) Background heart failure treatment should be optimized, 2) Oral anticoagulant is generally indicated when AF is present, 3) Ventricular rate control is required. Beta-blockers are preferred over digitalis and have favorable effects on mortality and morbidity in patients with systolic heart failure. 4) The rhythm control strategy has not been shown to be superior to rate control in heart failure patients with AF (AF-CHF trial). However, restoration of sinus rhythm may improve symptoms and hemodynamics in heart failure patients with AF. Amiodarone can be safely used in patients with heart failure. In patients with AF and severe and unstable heart failure, intravenous amiodarone should be used to maintain sinus rhythm. The goal of pharmacological management is to improve in survival and quality of life in heart failure patients with AF. Atrial fibrillation (AF) frequently occurs in patients with heart failure. It is recognized that AF leads to clinical deterioration and results in worsening heart failure. AF also increases the risk of mortality and morbidity in patients with heart failure. ESC guideline 2010 introduces treatment recommendations for the management of AF in patients with heart failure. 1) Background heart failure treatment should be optimized, 2) Oral anticoagulant is generally indicated when AF is present, 3) Ventricular rate control is required. Beta-blockers are preferred over digitalis and have favorable effects on mortality and morbidity in patients with systolic heart failure. 4) The rhythm control strategy has not been shown to be superior to rate control in heart failure patients with AF (AF-CHF trial). However, restoration of sinus rhythm may improve symptoms and hemodynamics in heart failure patients with AF. Amiodarone can be safely used in patients with heart failure. In patients with AF and severe and unstable heart failure, intravenous amiodarone should be used to maintain sinus rhythm. The goal of pharmacological management is to improve in survival and quality of life in heart failure patients with AF.