Atrial fibrillation and heart failure: A contemporary review of current management approaches

Atrial fibrillation (AF) and heart failure (HF) frequently coexist and complicate the course of treatment of each other. AF with rapid ventricular conduction can lead to tachycardia-mediated cardiomyopathy, which is a reversible cause of cardiomyopathy. However, in most cases, AF is the manifestation of various underlying cardiomyopathies. Guideline-directed pharmacological and device therapy for HF is essential. The management options for AF and HF include pharmacological rhythm control, pharmacological rate control, and interventional approaches, which include catheter ablation for AF via pulmonary vein isolation and atrioventricular node ablation. This is a contemporary review to discuss the available evidence regarding the various management approaches in this specific patient group. Atrial fibrillation (AF) and heart failure (HF) frequently coexist and complicate the course of treatment of each other. AF with rapid ventricular conduction can lead to tachycardia-mediated cardiomyopathy, which is a reversible cause of cardiomyopathy. However, in most cases, AF is the manifestation of various underlying cardiomyopathies. Guideline-directed pharmacological and device therapy for HF is essential. The management options for AF and HF include pharmacological rhythm control, pharmacological rate control, and interventional approaches, which include catheter ablation for AF via pulmonary vein isolation and atrioventricular node ablation. This is a contemporary review to discuss the available evidence regarding the various management approaches in this specific patient group. Key Findings▪The treatment of atrial fibrillation (AF) in patients with heart failure (HF) begins with optimal guideline-directed management of HF.▪The management options for AF and HF include pharmacological rhythm control or rate control, as well as interventional approaches, which include catheter ablation for AF via pulmonary vein isolation and atrioventricular node ablation.▪Randomized trials have shown that rhythm control with catheter ablation via pulmonary vein isolation can improve symptoms, increase quality of life, and improve left ventricular ejection fraction.▪Catheter ablation should be used selectively, taking into consideration the patient’s comorbidities and risk of complications. ▪The treatment of atrial fibrillation (AF) in patients with heart failure (HF) begins with optimal guideline-directed management of HF.▪The management options for AF and HF include pharmacological rhythm control or rate control, as well as interventional approaches, which include catheter ablation for AF via pulmonary vein isolation and atrioventricular node ablation.▪Randomized trials have shown that rhythm control with catheter ablation via pulmonary vein isolation can improve symptoms, increase quality of life, and improve left ventricular ejection fraction.▪Catheter ablation should be used selectively, taking into consideration the patient’s comorbidities and risk of complications.