Management of Patients with Acute Heart Failure and Atrial Fibrillation

Acute heart failure (AHF) patients are commonly encountered in intensive care units (ICUs) and their managements are challenging to intensivists. Atrial fibrillation (AF) is one of the most common cardiac rhythms among patients of AHF. It is estimated that 20% to 30% of AHF patients have rapid AF during acute stage of hospital admission. The relationship between AHF and AF is complex in the sense that they interact with each other. Acute heart failure will cause rapid AF, and rapid AF may in turn precipitate AHF. When the above 2 conditions present together, the morbidity and mortality of patients will increase, attributable to both the underlying disease condition and from the therapy used. Intensivists taking care of AHF patients with rapid AF should carefully evaluate the patient and consider 3 different situations: 1. Patients with newly onset acute heart failure with newly onset AF; 2. Patients of chronic heart failure with newly onset AF; and 3. Patients of decompensated chronic heart failure with chronic AF and rapid ventricular response. Other considerations which will influence the treatment strategy include: 1. Is the patient's baseline left ventricular systolic function preserved or reduced? 2. What is the duration of the AF episode? 3. Is the patient already treated with antiarrhythmic drugs for rhythm control or using only rate control agents, with or without anticoagulation? 4. What comorbidities are present? In this article management strategies according to different clinical scenarios will be discussed.