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The management of atrial fibrillation in heart failure: an expert panel consensus

Dimitrios Farmakis1,2, Christina Chrysohoou3, Gregory Giamouzis4

  • 1Shakolas Educational Center for Clinical Medicine, University of Cyprus Medical School, Palaios dromos Lefkosias Lemesou No.215/6, Aglantzia, 2029, Nicosia, Cyprus. farmakis.dimitrios@ucy.ac.cy.

Heart Failure Reviews
|May 30, 2020
PubMed

Insights

Heart failure (HF) and atrial fibrillation (AF) frequently coexist, presenting diagnostic and management challenges. This expert review addresses these complex issues, highlighting evidence gaps for better patient outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Internal Medicine

Background:

  • Heart failure (HF) and atrial fibrillation (AF) share a strong bidirectional relationship, with each condition exacerbating the other.
  • The coexistence of HF and AF leads to significant clinical challenges, including diagnostic difficulties and complex management strategies.
  • Under-diagnosis of HF with preserved ejection fraction in AF patients and AF in HF patients is a critical issue.

Purpose of the Study:

  • To address challenging clinical issues arising from the frequent coexistence of heart failure and atrial fibrillation.
  • To outline existing evidence and identify knowledge gaps in managing patients with both HF and AF.
  • To provide expert insights on critical aspects of HF-AF management.

Main Methods:

  • Expert panel meeting convened to discuss challenging issues in HF-AF coexistence.
  • Review and synthesis of existing evidence on the interrelationship between HF and AF.
  • Identification of knowledge gaps requiring further research and clinical attention.

Main Results:

  • Challenges include under-diagnosis of HFpEF in AF and AF in HF.
  • Difficulties in characterizing atrial cardiomyopathy and managing anticoagulation in comorbid patients.
  • Uncertainties regarding rate control targets and rhythm control strategies, including catheter ablation.

Conclusions:

  • The frequent coexistence of HF and AF necessitates a focused approach to diagnosis and management.
  • Addressing diagnostic challenges, anticoagulation in complex patients, and optimal therapeutic strategies is crucial.
  • Further research is needed to fill identified knowledge gaps and improve patient outcomes.

Keywords:
Atrial fibrillationDirect oral anticoagulantsHeart failureNon-vitamin K antagonist oral anticoagulantsRate controlRhythm control

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