Open AccessTreatment of Atrial Fibrillation in Patients with Co-existing Heart Failure and Reduced Ejection Fraction: Time to Revisit the Management Guidelines?
Author(s) -
Alex Baher,
Nassir Marrouche
Publication year - 2018
Publication title -
arrhythmia and electrophysiology review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.008
H-Index - 18
eISSN - 2050-3377
pISSN - 2050-3369
DOI - 10.15420/aer.2018.17.2
Subject(s) - medicine , atrial fibrillation , ejection fraction , heart failure , context (archaeology) , cardiology , catheter ablation , clinical trial , stroke (engine) , population , intensive care medicine , randomized controlled trial , management of atrial fibrillation , paleontology , mechanical engineering , environmental health , engineering , biology
AF in patients with heart failure and reduced ejection fraction (HFrEF) is common and is associated with an increased risk of stroke, heart failure hospitalisation and all-cause mortality. Rhythm control of AF in this population has been traditionally limited to the use of antiarrhythmic drugs. Clinical trials assessing superiority of pharmacological rhythm control over rate control have been largely disappointing. Catheter ablation has emerged as a viable alternative to pharmacological rhythm control in symptomatic AF and has enjoyed significant technological advancements over the past decade. Recent clinical trials have suggested that catheter ablation is superior to pharmacological interventions in patients with co-existing AF and HFrEF. In this article, we will review the therapeutic options for AF in patients with HFrEF in the context of the latest clinical trials beyond the current established guidelines.
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