Atrial fibrillation in heart failure

Abstract

Atrial fibrillation occurs in 10% to 50% of patients with heart failure. Although it increases the risk of systemic emboli, removes an effective atrial contribution to ventricular filling, and adversely impacts on matching heart rate to demand, atrial fibrillation does not appear to have a major adverse effect on survival with present management strategies. Anticoagulation with warfarin and adequate rate control are important. Restoration of sinus rhythm has theoretical benefits, which have not been adequately tested, and the best management strategy is not known. Class I antiarrhythmic drugs should be avoided. Amiodarone is often effective in maintaining sinus rhythm, but whether the benefit offsets the risks is not yet established.