Heart failure and atrial fibrillation

Abstract

Heart failure and atrial fibrillation are often referred to as the epidemics of the 21st century. They are conditions characterized by an appreciably increasing incidence with increasing age - the typical patient is over 70 years old. The prerequisite for successful drug therapy of both conditions is effective oral anticoagulation and an individualized choice between rhythm versus rate control in an effort to prevent sudden cardiac death or progression of heart failure. Optimal therapy of heart failure should control symptoms and prevent the onset of new atrial fibrillation. The question whether to control rhythm or rate in the treatment of atrial fibrillation has to date been investigated in patients with preserved left ventricular ejection fraction, that is, those without heart failure. However, some reports have pointed out that maintaining sinus rhythm significantly improves the prognosis of heart failure and prevents its deterioration. Atrioventricular junction ablation with subsequent pacing or, possibly, biventricular pacing, seem to be particularly beneficial in patients with severe heart failure. Ostial ablation or, better still, electrical isolation of pulmonary veins by surgery or radiofrequency ablation is currently the method of choice.