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Atrial fibrillation and heart failure: beyond the heart rate

Garg, Anuj; Akoum, Nazem

Current Opinion in Cardiology: May 2013 - Volume 28 - Issue 3 - p 332–336
doi: 10.1097/HCO.0b013e32835fb710
CARDIAC FAILURE: Edited by David Feldman and Josef Stehlik

Purpose of review Atrial fibrillation and heart failure are two of the most prevalent cardiovascular disease conditions. They often coexist and lead to significant morbidity and mortality. Adequate management strategies for this dual epidemic continue to be the subject of many research studies.

Recent findings Recent clinical trials suggest that a rhythm control strategy for atrial fibrillation does not offer a survival advantage over rate control in heart failure patients with reduced systolic function. Rhythm control in these trials was achieved using antiarrhythmic drugs, with evidence of increased mortality associated with certain agents. Catheter ablation is a more effective and increasingly used approach to maintain sinus rhythm in atrial fibrillation patients, with promising results in the heart failure population. Late-gadolinium-enhancement cardiac MRI (LGE-MRI) assessment of atrial fibrosis helps in selecting the better candidates for atrial fibrillation ablation. AV nodal ablation and bi-ventricular pacing remains another viable option. Atrial fibrillation patients with heart failure and preserved systolic function are another group in whom maintenance of sinus rhythm is thought to be advantageous.

Summary Patients with atrial fibrillation and heart failure are a heterogeneous group and require a personalized treatment approach. Catheter ablation to restore and maintain sinus rhythm is a modality that promises to be advantageous beyond rate control.

University of Utah Division of Cardiology, Section of Cardiac Electrophysiology, Utah, USA

Correspondence to Nazem Akoum, MD, MS, FHRS, 50 North Medical Drive, Rm 4A100 Salt Lake City, UT 84132, USA. Tel: +1 801 213 23 87; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.