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Management of Atrial Tachyarrhythmias in Heart Failure—an Interventionalist’s Point of View

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Abstract

Purpose of Review

Atrial fibrillation (AF) and heart failure (HF) are commonly encountered clinical disorders that often co-exist, accelerating disease progression and adverse outcomes. It is known that restoration of sinus rhythm positively impacts this population; however, the complex comorbidity profile associated with HF introduces intricacies not encountered in other patient populations. The current review focuses on the safety and efficacy of an interventional-based management for atrial tachyarrhythmias in HF.

Recent Findings

While pharmacotherapy has been the standard treatment of cardiac dysrhythmias in the HF population, recent evidence suggests catheter ablation is more effective and causes less harm than antiarrhythmic drugs (AADs) in the HF population.

Summary

For the maintenance of sinus rhythm, catheter ablation results in improved freedom from recurrent arrhythmia, with secondary benefit on mortality and hospitalization in those with HF and reduced ejection fraction. For those with permanent AF, cardiac resynchronization therapy and atrioventricular junction ablation result in improved quality of life, physical functioning, and cardiac function.

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Authors and Affiliations

  1. University of British Columbia, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada

    Jason A. Gencher, Nathaniel M. Hawkins, Marc W. Deyell & Jason G. Andrade

  2. Center for Cardiovascular Innovation, Vancouver, Canada

    Nathaniel M. Hawkins, Marc W. Deyell & Jason G. Andrade

  3. Montreal Heart Institute, Université de Montréal, Montreal, Canada

    Jason G. Andrade

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  1. Jason A. Gencher
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  2. Nathaniel M. Hawkins
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  4. Jason G. Andrade
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Correspondence to Jason G. Andrade.

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Conflict of Interest

JG has nothing to declare. NH received speakers’ fees from Novartis. MD reports grants and personal fees from Biosense-Webster and personal fees from Abbott, Boston Scientific, and Medtronic. JA received grants and personal fees from Medtronic, Bayer, BMS-Pfizer, and Servier and personal fees from Biosense-Webster.

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Gencher, J.A., Hawkins, N.M., Deyell, M.W. et al. Management of Atrial Tachyarrhythmias in Heart Failure—an Interventionalist’s Point of View. Curr Heart Fail Rep 19, 126–135 (2022). https://doi.org/10.1007/s11897-022-00543-4

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