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Atrial Fibrillation and Heart Failure: Untangling a Modern Gordian Knot

Allan C Skanes1, Anthony S L Tang1

  • 1London Heart Rhythm Program, Western University, London, Ontario, Canada.

The Canadian Journal of Cardiology
|November 9, 2018
PubMed

Insights

Heart failure (HF) and atrial fibrillation (AF) often coexist, increasing mortality. Catheter ablation to restore sinus rhythm shows promise for improving HF symptoms and function, though long-term outcomes require further study.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • Heart failure (HF) and atrial fibrillation (AF) are prevalent, especially in aging populations, with combined mortality significantly higher than individual conditions.
  • A complex interplay exists between AF and HF, involving shared risk factors and intertwined pathophysiological mechanisms.
  • Asymptomatic left ventricular dysfunction can worsen or be worsened by AF, leading to HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF).

Purpose of the Study:

  • To review the relationship between AF and HF, focusing on pathophysiology and treatment strategies.
  • To evaluate the impact of restoring sinus rhythm on HF outcomes, particularly concerning catheter ablation versus pharmacological approaches.

Main Methods:

  • Review of existing literature on the pathophysiology and management of coexisting AF and HF.
  • Analysis of recent studies investigating the efficacy of catheter ablation for achieving sinus rhythm in HF patients.
  • Comparison of outcomes between pharmacological rhythm control and catheter ablation in HF populations.

Main Results:

  • Pharmacological restoration of sinus rhythm has not demonstrated significant improvements in cardiovascular or total mortality for HF patients.
  • Recent studies suggest catheter ablation to achieve sinus rhythm may significantly improve symptoms, cardiac function, and potentially reduce mortality in HF patients.
  • The long-term prognostic impact of catheter ablation on HF outcomes remains under investigation.

Conclusions:

  • While traditional treatments have improved quality of life for HF patients, prognosis alteration remains limited.
  • Catheter ablation for AF in HF patients presents a promising strategy for improving clinical outcomes and cardiac function.
  • Further research is needed to definitively establish the long-term benefits and optimal role of catheter ablation in managing HF.

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