Managing Atrial Fibrillation in Heart Failure: In Whom, When, and How?

Area of Science:

• Cardiology
• Electrophysiology
• Heart Failure Management

Background:

• Atrial fibrillation (AF) and heart failure (HF) frequently coexist, worsening each other's progression and outcomes.
• Managing AF in HF patients requires complex decisions on rhythm control, rate control, and anticoagulation.

Purpose of the Study:

• To synthesize current evidence on managing AF in HF patients.
• To provide a pragmatic clinical algorithm for integrated, patient-centered AF management in HF.

Main Methods:

• Narrative review of recent randomized trials and updated guidelines.
• Analysis of pathophysiological mechanisms linking AF and HF.
• Evaluation of rhythm control strategies, including catheter ablation.

Main Results:

• Early rhythm control, especially catheter ablation, improves survival and reduces HF hospitalizations in selected HF patients with reduced ejection fraction.
• Shared pathophysiological mechanisms include neurohormonal activation, structural remodeling, and atrial myopathy.
• Direct oral anticoagulants are central for reducing thromboembolic risk.

Conclusions:

• Catheter ablation is a preferred rhythm-control strategy for HF with reduced ejection fraction.
• Optimal timing and method for AF intervention depend on patient-specific factors.
• Integrated, multidisciplinary, and patient-centered care is crucial for managing AF in HF.