Atrial Fibrillation Ablation in Heart Failure Patients

Abstract

Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome.

Keywords: atrial fibrillation; catheter ablation; heart failure.

Figure 1

Catheter Ablation Rhythm Control vs. Medical Therapy: (1) Catheter ablation rhythm control vs. medical therapy for all-cause mortality; (2) Catheter ablation rhythm control vs. medical therapy for rehospitalization. Only a composite endpoint (including death, disabling stroke, serious bleeding, or cardiac arrest) was available in the CABANA HF subgroup.