Atrial Fibrillation Ablation in Heart Failure Patients

Abstract

Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome.

Atrial Fibrillation Associated with Heart Failure: Perspectives from Recent Large Clinical Studies and Translational Research

“…The combination of AF and HF and the order in which these two conditions occur may affect prognosis, which seems worse when HF precedes AF [6]. The review by Derndofer et al emphasized that AF and HF have the potential to interfere with each other and proper selection and timing are crucial when implementing different treatment strategies in patients with AF and HF [11]. Early rhythm control (whether with antiarrhythmic drug or with catheter ablation) should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcomes [11,12].…”

“…The review by Derndofer et al emphasized that AF and HF have the potential to interfere with each other and proper selection and timing are crucial when implementing different treatment strategies in patients with AF and HF [11]. Early rhythm control (whether with antiarrhythmic drug or with catheter ablation) should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcomes [11,12]. In the event of haemodynamic instability or worsening HF, electrical cardioversion should be performed as an emergency measure; otherwise, pharmacological cardioversion with intravenous amiodarone is preferred [2].…”

“…Both may be seen as the cause or consequence of the other and treating one condition may treat the other and may improve the general prognosis. Catheter ablation of AF in patients with HF increases the likelihood of restoring sinus rhythm, thus reducing palpitations and improving LV function, functional capacity, and symptoms of HF [2,11]. AF ablation in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing deaths, as mentioned above, provided that LVEF >= 25% [11].…”

“…Catheter ablation of AF in patients with HF increases the likelihood of restoring sinus rhythm, thus reducing palpitations and improving LV function, functional capacity, and symptoms of HF [2,11]. AF ablation in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing deaths, as mentioned above, provided that LVEF >= 25% [11]. The general approach to managing AF may markedly differ between HF and non-HF patients.…”