Atrial Fibrillation and Heart Failure

Atrial fibrillation is common in heart failure patients and is associated with increased mortality.Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy.Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking.

Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases.Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing.Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.