The management of atrial fibrillation in patients with heart failure
- Brian Olshansky, MD
Brian Olshansky, MD
- Section Editor — Cardiac Arrhythmias
- Professor Emeritus of Medicine
- University of Iowa Hospitals and Clinics
- Section Editors
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- Bradley P Knight, MD, FACC
Bradley P Knight, MD, FACC
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
For patients with atrial fibrillation (AF), the main goals of therapy are control of symptoms, prevention of cardiac dysfunction, and prevention of arterial thromboembolism, particularly stroke. These goals are also appropriate for the relatively large subset of AF patients with heart failure (HF). In these individuals, symptoms are frequent and potentially disabling due to the interaction between the two processes.
This topic will focus on the management of AF in patients with HF. There are few differences in management between those with systolic or diastolic HF. (See "Overview of the therapy of heart failure with reduced ejection fraction" and "Use of beta blockers in heart failure with reduced ejection fraction" and "Treatment and prognosis of heart failure with preserved ejection fraction" and "Pathophysiology of diastolic heart failure" and "Clinical manifestations and diagnosis of heart failure with preserved ejection fraction".)
The reader will be referred to other AF topics for which care is relatively similar irrespective of the presence of HF. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization", section on 'Summary and recommendations' and "Control of ventricular rate in atrial fibrillation: Pharmacologic therapy" and "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications", section on 'Efficacy'.)
Atrial fibrillation (AF) and heart failure (HF) often co-exist. The presence of one increases the likelihood of the other .
The temporal associations of AF and HF and potential differences in preserved (HFpEF) versus reduced ejection fraction (HFrEF) were examined in an analysis of over 10,000 individuals in the original Framingham Heart Study with new onset AF or HF between 1980 and 2012 . The following was noted in this study:
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- EFFECT ON CARDIAC FUNCTION
- CORRECTION OF REVERSIBLE CAUSES OF AF AND HF
- ACUTE MANAGEMENT
- SYSTOLIC OR DIASTOLIC HEART FAILURE
- Rhythm versus rate control
- PATIENTS WITH REDUCED EJECTION FRACTION
- Rhythm control
- - Our initial approach to rhythm control
- - Electrical cardioversion
- - Antiarrhythmic drug therapy
- - Beta blockers for rhythm control
- - Possible role of angiotensin inhibition
- - Catheter ablation
- Rate control
- - Our approach to rate control
- - Rate-control goal
- - AV node ablation with pacing
- HEART FAILURE WITH PRESERVED EJECTION FRACTION
- RECOMMENDATIONS OF OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS