Atrial fibrillation ablation in heart failure

Abstract

This review focuses on the current evidence and clinical trials about catheter ablation for atrial fibrillation in heart failure. Beyond the differences of antiarrhythmic drug therapy and catheter ablation, we also detailed the existing evidence on atrial fibrillation ablation in heart failure. We also considered the subpopulation with reduced or preserved ejection fraction and outlined some evidence-based decision-making recommendations. The current atrial fibrillation management guideline follows a symptom-based approach, however, due to the high mortality, there is an increasing demand for life-prolonging therapeutic options in cases with concomitant heart failure. Catheter ablation should be considered as a first-line treatment option in this patient population to reduce mortality and hospitalization due to heart failure, however the results of the clinical trials were controversial. Since the antiarrhythmic drug therapy is often ineffective, poorly toler-ated or contraindicated in this patient population, pulmonary vein isolation is of paramount importance. However, we lack evidence regarding the efficacy of additional ablation techniques. We believe that instead of standardized care, an individually tailored clinical approach is more beneficial in patients with atrial fibrillation and heart failure.