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The management of atrial fibrillation in heart failure

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Opinion statement

The development of atrial fibrillation (AF) can greatly complicate the course of heart failure (HF). Although recent trials have indicated the nonsuperiority of a rhythm control strategy in the general population with AF, this may not apply to patients with HF. We feel strongly that AF be treated aggressively in patients with HF, defaulting toward an initial rhythm control strategy, to avoid the hemodynamic detriment of irregular rapid ventricular response and the development of tachycardia-related myopathy. The index episode is treated with cardioversion and antiarrhythmic therapy. If significant benefit is demonstrated, the rhythm control strategy is maintained, to the point of catheter ablation for AF if necessary. If there is no change in cardiac performance or symptoms after cardioversion, strict rate control is enforced, to the point of atrioventricular node ablation and pacing if necessary.

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Authors and Affiliations

  1. Cardiovascular Division, Department of Electrophysiology, Hospital of The University of Pennsylvania, 9 Founders, 3400 Spruce Street, 19104, Philadelphia, PA, USA

    David J. Callans MD

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  1. Rupa Bala MD
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  2. David J. Callans MD
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Bala, R., Callans, D.J. The management of atrial fibrillation in heart failure. Curr Treat Options Cardio Med 8, 325–333 (2006). https://doi.org/10.1007/s11936-006-0053-3

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  • DOI: https://doi.org/10.1007/s11936-006-0053-3

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