The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department

Abstract

Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.

Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis

“…For patients with HF who experience tachyarrhythmia, the options for acute pharmaceutical interventions are limited [ 34 ]. For hemodynamically stable patients, opting for rate control is a viable strategy until further planning is established, as in cases of AF, when ensuring the coagulation status precedes cardioversion [ 35 , 36 , 37 ]. In patients with LVEF < 40%, apart from beta-blockers, only digoxin is an alternative option for rapid rate control [ 38 ].…”