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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial fibrillation in heart failure: a comprehensive review
Prakash C Deedwania1, Joel A Lardizabal
1Department of Medicine, University of California, San Francisco, USA. pdeedwania@fresno.ucsf.edu
Insights
Chronic heart failure and atrial fibrillation are linked, worsening patient outcomes. Current rate control is standard for atrial fibrillation in heart failure due to limitations in rhythm control therapies.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Chronic heart failure (CHF) and atrial fibrillation (AF) are frequently comorbid conditions.
- Their coexistence significantly worsens patient prognosis and increases mortality.
- The interaction involves complex pathophysiological mechanisms beyond shared risk factors.
Purpose of the Study:
- To review the complex relationship between atrial fibrillation and heart failure.
- To discuss current and emerging therapeutic strategies for managing AF in CHF patients.
Main Methods:
- Literature review of existing studies on the pathophysiology and management of comorbid CHF and AF.
- Analysis of current therapeutic guidelines and emerging treatment modalities.
Main Results:
- Rate control remains the standard of care for AF in heart failure, as rhythm control strategies have not improved mortality or morbidity.
- Existing anti-arrhythmic drugs have limitations, and long-term data for surgical and catheter-based therapies are needed.
- Non-anti-arrhythmic agents are being investigated for their potential role.
Conclusions:
- A deeper understanding of the intricate relationship between AF and heart failure is crucial for optimizing management.
- Future research should focus on improving therapeutic strategies beyond current limitations.
Abstract:
Chronic heart failure and atrial fibrillation are 2 major disorders that are closely linked. Their coexistence is associated with adverse prognosis. Both share several common predisposing conditions, but their interaction involves complex ultrastructural, electrophysiologic, and neurohormonal processes that go beyond mere sharing of mutual risk factors. Rate control approach remains the standard therapy for atrial fibrillation in heart failure because current strategies at rhythm control have so far failed to positively impact mortality and morbidity. This is largely because of the shortcomings of current pharmacologic anti-arrhythmic agents. Surgical and catheter-based therapies are promising, but long-term data are lacking. The role of non-anti-arrhythmic therapeutic agents also is being explored. Further progress toward improved understanding the complex relationship between atrial fibrillation and heart failure should improve management strategies.
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