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Atrial Fibrillation Management in Heart Failure: Interrupting the Vicious Cycle

  • Arrhythmia (R Kabra, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

In this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure.

Recent findings

While rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outcomes in patients with coexisting heart failure.

Summary

Atrial fibrillation is the most common arrhythmia that frequently coexists with heart failure. The incidence of one condition increases in the presence of the other posing a significant treatment challenge. Despite ample advancement in management strategies of atrial fibrillation and heart failure, this combination is associated with higher morbidity and mortality when found in the same patient. The treatment goal in these patients is to improve quality of life by controlling symptoms and to prevent thromboembolism with appropriate anticoagulation. Catheter ablation is a promising treatment option for symptomatic patients with depressed ventricular function. Finally, pacing with cardiac resynchronization therapy after AV nodal ablation should be considered when strict control of ventricular rate is desired in atrial fibrillation patients who meet the criteria for device implantation.

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Funding

This work was supported by the National Institutes of Health National Institutes of Health grants (NIGMS 5 P20 GM121307–02 Center for Redox Biology and Cardiovascular Disease).

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  1. Tina Firouzbakht and Usman Mustafa contributed equally to this work.

Authors and Affiliations

  1. The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & Sciences, Louisiana State, University Health Sciences Center- Shreveport (LSUHSC-S), 1501 Kings Hwy, Shreveport, LA, 71103, USA

    Tina Firouzbakht MD, Usman Mustafa MD, Sania Jiwani MD & Paari Dominic MD

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  1. Tina Firouzbakht MD
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Correspondence to Paari Dominic MD.

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Tina Firouzbakht declares that she has no conflict of interest. Usman Mustafa declares that he has no conflict of interest. Sania Jiwani declares that she has no conflict of interest. Paari Dominic declares that he has no conflict of interest.

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Firouzbakht, T., Mustafa, U., Jiwani, S. et al. Atrial Fibrillation Management in Heart Failure: Interrupting the Vicious Cycle. Curr Treat Options Cardio Med 22, 12 (2020). https://doi.org/10.1007/s11936-020-00812-2

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