Skip to main content
Log in

Atrial fibrillation and congestive heart failure

  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Atrial fibrillation (AF) and congestive heart failure (CHF) are common cardiac conditions that frequently coexist. There is a complex interplay between the two conditions, with each increasing the morbidity and mortality associated with the other. The management of AF in patients with CHF requires special care because of the increased risk of antiarrhythmic drug therapy in the group. This report reviews current treatment options and assesses the role of the newer therapies of biventricular pacing for CHF and radiofrequency ablation for AF. It also discusses results of the AF-CHF study, which were reported in November 2007.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Braunwald E: Shattuck lecture—cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med 1997, 337:1360–1369.

    Article  PubMed  CAS  Google Scholar 

  2. Cha YM, Redfield MM, Shen WK, Gersh BJ: Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle. Circulation 2004, 109:2839–2843.

    Article  PubMed  Google Scholar 

  3. Wyse DG, Waldo AL, DiMarco JP, et al.: A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 2002, 347:1825–1833.

    PubMed  CAS  Google Scholar 

  4. Ehrlich JR, Nattel S, Hohnloser SH: Atrial fibrillation and congestive heart failure: specific considerations at the intersection of two common and important cardiac disease sets. J Cardiovasc Electrophysiol 2002, 13:399–405.

    Article  PubMed  Google Scholar 

  5. Khand AU, Rankin AC, Kaye GC, Cleland JG: Systematic review of the management of atrial fibrillation in patients with heart failure. Eur Heart J 2000, 21:614–632.

    Article  PubMed  CAS  Google Scholar 

  6. Li D, Shinagawa K, Pang L, et al.: Effects of angiotensin-converting enzyme inhibition on the development of the atrial fibrillation substrate in dogs with ventricular tachypacing-induced congestive heart failure. Circulation 2001, 104:2608–2614.

    Article  PubMed  CAS  Google Scholar 

  7. Cha TJ, Ehrlich JR, Zhang L, et al.: Dissociation between ionic remodeling and ability to sustain atrial fibrillation during recovery from experimental congestive heart failure. Circulation 2004, 109:412–418.

    Article  PubMed  Google Scholar 

  8. Dries DL, Exner DV, Gersh BJ, et al.: Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 1998, 32:695–703.

    Article  PubMed  CAS  Google Scholar 

  9. Boyle NG, Wang X, Hepner A, et al.: Survival in patients with atrial fibrillation and advanced heart failure [abstract]. Circulation 2002, 106:II–681.

    Google Scholar 

  10. Chaudhry GM, Haffajee CI: Algorithms useful in the treatment of atrial fibrillation. Curr Opin Cardiol 2002, 17:52–57.

    Article  PubMed  Google Scholar 

  11. Fuster V, Ryden LE, Cannom DS, et al.: ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006, 114:e257–e354. [Published erratum appears in Circulation 2007, 116:e138.]

    Article  PubMed  Google Scholar 

  12. Hart RG, Halperin JL: Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Intern Med 1999, 131:688–695.

    PubMed  CAS  Google Scholar 

  13. Singer DE, Albers GW, Dalen JE, et al.: Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004, 126:429S–456S.

    Article  PubMed  CAS  Google Scholar 

  14. Farshi R, Kistner D, Sarma JS, et al.: Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol 1999, 33:304–310.

    Article  PubMed  CAS  Google Scholar 

  15. Wood MA, Brown-Mahoney C, Kay GN, Ellenbogen KA: Clinical outcomes after ablation and pacing therapy for atrial fibrillation: a meta-analysis. Circulation 2000, 101:1138–1144.

    PubMed  CAS  Google Scholar 

  16. Khand AU, Rankin AC, Martin W, et al.: Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure? J Am Coll Cardiol 2003, 42:1944–1951.

    Article  PubMed  CAS  Google Scholar 

  17. Brignole M, Menozzi C, Gianfranchi L, et al.: Assessment of atrioventricular junction ablation and VVIR pacemaker versus pharmacological treatment in patients with heart failure and chronic atrial fibrillation: a randomized, controlled study. Circulation 1998, 98:953–960.

    PubMed  CAS  Google Scholar 

  18. Doval HC, Nul DR, Grancelli HO, et al.: Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA). Lancet 1994, 344:493–498.

    Article  PubMed  CAS  Google Scholar 

  19. Torp-Pedersen C, Moller M, Bloch-Thomsen PE, et al.: Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group. N Engl J Med 1999, 341:857–865.

    Article  PubMed  CAS  Google Scholar 

  20. Van Gelder IC, Hagens VE, Bosker HA, et al.: A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002, 347:1834–1840.

    Article  PubMed  Google Scholar 

  21. Hohnloser SH, Kuck KH, Lilienthal J: Rhythm or rate control in atrial fibrillation-Pharmacological Intervention in Atrial Fibrillation (PIAF): a randomised trial. Lancet 2000, 356:1789–1794.

    Article  PubMed  CAS  Google Scholar 

  22. Pedersen OD, Brendorp B, Elming H, et al.: Does conversion and prevention of atrial fibrillation enhance survival in patients with left ventricular dysfunction? Evidence from the Danish Investigations of Arrhythmia and Mortality ON Dofetilide/(DIAMOND) study. Card Electrophysiol Rev 2003, 7:220–224.

    Article  PubMed  Google Scholar 

  23. Corley SD, Epstein AE, DiMarco JP, et al.: Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation 2004, 109:1509–1513.

    Article  PubMed  Google Scholar 

  24. Rationale and design of a study assessing treatment strategies of atrial fibrillation in patients with heart failure: the Atrial Fibrillation and Congestive Heart Failure (AF-CHF) trial. Am Heart J 2002, 144:597–607.

  25. Roy D: The Atrial Fibrillation and Congestive Heart Failure (AF-CHF) Trial. Presented at American Heart Association 2007 Scientific Sessions. Orlando; November 4–7, 2007. Available at http://scientificsessions.americanheart.org/portal/scientificsessions/ss/lbctnr9a.2007. Accessed January 25, 2007.

  26. Singh BN, Connolly SJ, Crijns HJ, et al.: Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter. N Engl J Med 2007, 357:987–999.

    Article  PubMed  CAS  Google Scholar 

  27. Kathofer S, Thomas D, Karle CA: The novel antiarrhythmic drug dronedarone: comparison with amiodarone. Cardiovasc Drug Rev 2005, 23:217–230.

    PubMed  CAS  Google Scholar 

  28. Pedersen OD, Bagger H, Kober L, Torp-Pedersen C: Trandolapril reduces the incidence of atrial fibrillation after acute myocardial infarction in patients with left ventricular dysfunction. Circulation 1999, 100:376–380.

    PubMed  CAS  Google Scholar 

  29. Vermes E, Tardif JC, Bourassa MG, et al.: Enalapril decreases the incidence of atrial fibrillation in patients with left ventricular dysfunction: insight from the Studies Of Left Ventricular Dysfunction (SOLVD) trials. Circulation 2003, 107:2926–2931.

    Article  PubMed  Google Scholar 

  30. Ueng KC, Tsai TP, Yu WC, et al.: Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation. Results of a prospective and controlled study. Eur Heart J 2003, 24:2090–2098.

    Article  PubMed  CAS  Google Scholar 

  31. Madrid AH, Bueno MG, Rebollo JM, et al.: Use of irbesartan to maintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: a prospective and randomized study. Circulation 2002, 106:331–336.

    Article  PubMed  CAS  Google Scholar 

  32. Heidbuchel H: A paradigm shift in treatment for atrial fibrillation: from electrical to structural therapy? Eur Heart J 2003, 24:2077–2078.

    Article  PubMed  Google Scholar 

  33. Leon AR, Greenberg JM, Kanuru N, et al.: Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 2002, 39:1258–1263.

    Article  PubMed  Google Scholar 

  34. Leclercq C, Walker S, Linde C, et al.: Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 2002, 23:1780–1787.

    Article  PubMed  CAS  Google Scholar 

  35. Lellouche N, De Diego C, Vaseghi M, et al.: Cardiac resynchronization therapy response is associated with shorter duration of atrial fibrillation. Pacing Clin Electrophysiol 2007, 30:1363–1368.

    Article  PubMed  Google Scholar 

  36. Yannopoulos D, Lurie KG, Sakaguchi S, et al.: Reduced atrial tachyarrhythmia susceptibility after upgrade of conventional implanted pulse generator to cardiac resynchronization therapy in patients with heart failure. J Am Coll Cardiol 2007, 50:1246–1251.

    Article  PubMed  Google Scholar 

  37. Padeletti L: Atrial fibrillation in heart failure patients implanted with a cardiac resynchronization therapy device: 1-year results of the randomized MASCOT study. Presented at American Heart Association 2007 Scientific Sessions. Orlando; November 4–7, 2007. Available at http://scientificsessions.americanheart.org/portal/secintificsessions/ss/lbctnr10.2007. Accessed November 6, 2007.

  38. Hsu LF, Jais P, Sanders P, et al.: Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 2004, 351:2373–2383.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Noel G. Boyle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Boyle, N.G., Shivkumar, K. Atrial fibrillation and congestive heart failure. Curr Heart Fail Rep 5, 11–15 (2008). https://doi.org/10.1007/s11897-008-0003-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11897-008-0003-3

Keywords

Navigation