Update on management of atrial fibrillation in heart failure: a focus on ablation.

Published on Jun 4, 2021in Heart5.213
· DOI :10.1136/HEARTJNL-2020-318081
Bart A. Mulder10
Estimated H-index: 10
(UMCG: University Medical Center Groningen),
Michiel Rienstra54
Estimated H-index: 54
(UMCG: University Medical Center Groningen)
+ 1 AuthorsYuri Blaauw24
Estimated H-index: 24
(UMCG: University Medical Center Groningen)
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Abstract
Atrial fibrillation is increasingly encountered in patients with heart failure. Both diseases have seen tremendous rises in incidence in recent years. In general, the treatment of atrial fibrillation is focused on relieving patients from atrial fibrillation-related symptoms and risk reduction for thromboembolism and the occurrence or worsening of heart failure. Symptomatic relief may be accomplished by either (non-)pharmacological rate or rhythm control in combination with optimal therapy of underlying cardiovascular morbidities and risk factors. Atrial fibrillation ablation has been performed in patients without overt heart failure successfully for many years. However, in recent years, attempts have been made for patients with heart failure as well. In this review, we discuss the current literature describing the treatment of atrial fibrillation in heart failure. We highlight the early rate versus rhythm control studies, the importance of addressing underlying conditions and treatment of risk factors. A critical evaluation will be performed of the catheter ablation studies that have been performed so far in light of larger (post-hoc) ablation studies. Furthermore, we will hypothesise the role of patient selection as next step in optimising outcome for patient with atrial fibrillation and heart failure.
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#1Meelad I H Al-Jazairi (UMCG: University Medical Center Groningen)H-Index: 4
#2B O Nguyen (UMCG: University Medical Center Groningen)H-Index: 2
Last. Race InvestigatorsH-Index: 7
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Aims Maintaining sinus rhythm in patients with persistent atrial fibrillation (AF) is challenging. We explored the efficacy of class I and III antiarrhythmic drugs (AADs) in patients with persistent AF and mild to moderate heart failure (HF). Methods and results In the RACE 3 trial, patients with early persistent symptomatic AF and short history of mild to moderate HF with preserved or reduced left ventricular ejection fraction (LVEF) were randomized to targeted or conventional therapy. Both gro...
1 CitationsSource
#1Bart A. Mulder (UMCG: University Medical Center Groningen)H-Index: 10
#2Justin G.L.M. Luermans (UM: Maastricht University)H-Index: 15
Last. Yuri Blaauw (UMCG: University Medical Center Groningen)H-Index: 24
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Treatment of symptomatic atrial fibrillation has seen important changes in the past decades. Advancements have especially been made in the field of non-pharmacological treatment of this disease. Patients in whom a rhythm control strategy is chosen the place of catheter ablation has become more frontline therapy in the past years. The procedure itself has also seen changes in technologies that can be used, either using point-by-point radiofrequency or one of the single-shot techniques. One of the...
1 CitationsSource
#1Douglas L. Packer (Mayo Clinic)H-Index: 76
#1Douglas L. PackerH-Index: 26
Last. Daniel B. Mark (Duke University)H-Index: 136
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Background: In patients with heart failure (HF) and atrial fibrillation (AF), several clinical trials have reported improved outcomes, including freedom from AF recurrence, quality of life (QOL), a...
2 CitationsSource
#1Johannes BrachmannH-Index: 58
#2Christian Sohns (RUB: Ruhr University Bochum)H-Index: 25
Last. Nassir F. Marrouche (Tulane University)H-Index: 7
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Abstract Objectives This subanalysis of the CASTLE-AF trial (Catheter Ablation vs. Standard Conventional Treatment in Patients With LV Dysfunction and AF) aimed to address the association between atrial fibrillation (AF) recurrence, AF burden, and hard clinical outcomes in heart failure (HF) patients with AF. Background The CASTLE-AF trial demonstrated the benefit of CA compared to pharmacological treatment in decreasing mortality and CV hospitalizations in patients with AF and HFrEF. However, t...
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#1Gerhard HindricksH-Index: 90
#2Tatjana S. PotparaH-Index: 37
Last. Caroline L WatkinsH-Index: 35
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#2Michiel Rienstra (UMCG: University Medical Center Groningen)H-Index: 54
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Premature ventricular complexes (PVCs) are often observed in patients presenting with heart failure with a reduced ejection fraction (HFrEF). PVCs may in some patients be considered to be the cause of heart failure, while in others it may be the consequence of heart failure. PVCs are important prognostic markers in HFrEF. The uncertainty whether PVCs are the cause or effect in HFrEF impacts clinical decision making. In this review, we discuss the complexity of the cause–effect relationship betwe...
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#1Paulus Kirchhof (UHH: University of Hamburg)H-Index: 108
#2A. John Camm (UHH: University of Hamburg)H-Index: 18
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Abstract Background Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. It is unclear whether earl...
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#1Shaojie ChenH-Index: 12
Last. K.R. Julian ChunH-Index: 29
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AIMS: The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints. METHODS AND RESULTS: Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and H...
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#1Roger A. Winkle (Palo Alto Medical Foundation)H-Index: 4
#2R. Hardwin Mead (Palo Alto Medical Foundation)H-Index: 4
Last. Rob A. Patrawala (Palo Alto Medical Foundation)H-Index: 4
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Background Little is known about the long-term outcomes and predictors of success for High Power Short Duration(HPSD) Contact Force(CF) atrial fibrillation(AF) ablations. Objectives To determine long-term freedom from AF and predictors of freedom from AF for 50W 5-15 second CF ablation. Methods We examined 4-year outcomes and predictors of freedom from AF after AF ablation for 1250 consecutive patients undergoing HPSD CF ablations. Results The demographic were: age=66.6±10.5, female=30.9%, LA si...
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#1Bart A. Mulder (UMCG: University Medical Center Groningen)H-Index: 10
#2Dirk J. van Veldhuisen (UMCG: University Medical Center Groningen)H-Index: 141
Last. Michiel Rienstra (UMCG: University Medical Center Groningen)H-Index: 54
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