Recent advances in management of atrial fibrillation in patients with heart failure

Atrial fibrillation is common in patients with heart failure (HF) and its presence confers major prognostic implications. However, effective management of these patients is still under development. The objective of this review is to provide an overview of atrial fibrillation in HF, and the implications for management.

At present there is no evidence that a rhythm control strategy may bring any long-term benefits in routine management of atrial fibrillation in HF. Recently, the procedure of pulmonary vein isolation has been shown to provide clinical and prognostic benefits in patients with atrial fibrillation and concomitant HF who remain symptomatic despite optimal medical therapy, including rate and rhythm control. A meta-analysis of patients with atrial fibrillation and symptomatic HF who had implanted cardiac resynchronization therapy devices and performed atrioventricular node ablation showed significant reduction in all-cause and cardiovascular mortality, and improvement in HF functional class.

A cornerstone of management is stroke prevention, and anticoagulation is required for the vast majority of patients with atrial fibrillation and HF. Pulmonary vein isolation and atrioventricular node ablation may become a treatment of choice for selected (usually symptomatic) patients in the future, pending evidence from new controlled trials.