Left ventricular improvement after catheter ablation of atrial fibrillation: What ablation procedure and for whom?

It is well known that high heart rate, loss of atrial systole and variable diastolic time resulting from atrial fibrillation (AF) induce heart failure (HF), and that pathophysiological hemodynamic and hormonal mechanisms involved in HF create conditions for AF occurrence and maintenance. When these disorders coexist, a vicious circle is thus created. In this context, it seems obvious that restoring and maintaining sinus rhythm in patients with HF and AF should lead to clinical benefits. However, several clinical studies performed over the years have failed to demonstrate significant improvement in clinical endpoints by maintaining sinus rhythm with antiarrhythmic drugs compared to heart rate control. In the Rhythm Control Versus Rate Control for Atrial Fibrillation and Heart Failure (AF-CHF) trial, a randomized study comparing rhythm control with ventricular rate control in patients with HF (left ventricular ejection fraction [LVEF] <35%) and AF, no significant benefit of rhythm control was demonstrated in mortality or surrogate clinical endpoints. One possible explanation for those results was the