Management of atrial fibrillation in patients with congestive heart failure

An increase in the prevalence of both atrial fibrillation and congestive heart failure is occurring in part because of the demographic shift toward an aging population. These two clinical entities often coexist in the same patient, resulting in the worsening of symptoms and prognosis, rendering their management even more challenging. A large clinical trial is currently examining whether a rhythm-control strategy is superior to a rate-control strategy in patients with congestive heart failure. New nonpharmacologic therapies such as pulmonary vein isolation are undergoing clinical investigation and may also alter the management of these patients. At present, therapy for atrial fibrillation in patients with congestive heart failure should aim first at controlling heart rate to provide symptomatic relief; then sinus rhythm should be restored if symptoms persist or if congestive heart failure worsens. For a more definitive approach in managing these patients, the authors await further clinical trial data.