Atrial Fibrillation Ablation in Heart Failure: What Do We Know? What Can We Do?

Andrea Chiocchini; Maria Terricabras; Atul Verma

Disclosures

Europace. 2021;23(3):353-361. 

In This Article

Abstract and Introduction

Abstract

Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) are two conditions that frequently impact reciprocally on each other. Patients with HFrEF have an increased risk of stroke, hospitalization and mortality after they develop AF and vice versa, AF causing deterioration of the ejection fraction is also associated to increased mortality. Catheter ablation has emerged as an effective alternative to antiarrhythmic drug treatment to maintain sinus rhythm and some randomized trials have shown a potential benefit in terms of mortality and hospitalization. This review discusses the available evidence regarding catheter ablation treatment in this specific patient group.

Introduction

Separately, both atrial fibrillation (AF) and heart failure (HF) have had increasing impact on healthcare systems.[1] A steadily aging population with growing burden of cardiovascular comorbidities have led to a significant increase in the incidence of both diseases. Of particular importance, these two conditions can coexist and impact reciprocally on each other ('AF begets HF and HF begets AF').[2] It is now clear that each of these conditions can promote the occurrence of the other and they concur synergistically to a worse prognosis compared with either condition alone. Antiarrhythmic medications may be effective in managing AF but are often contraindicated in the presence of heart failure with reduced ejection fraction (HFrEF), catheter ablation (CA) of AF may arise as an alternative therapeutic option. Therefore, this review examines the scientific evidence regarding how to optimally treat AF in HF patients that still remains a major challenge for clinicians.

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