[Atrial fibrillation and heart failure: cause or effect?].
The association between atrial fibrillation and heart failure is well documented. Heart failure is one of the established predisposing conditions for the development of atrial fibrillation; conversely, heart failure is a common condition in patients with atrial fibrillation. In patients with heart failure the atrial electrophysiologic properties might be modified by hemodynamic overloading and neurohumoral activation. Atrial fibrillation promotes heart failure with multiple mechanisms including uncontrolled heart rate, loss of atrioventricular synchrony, irregularity in the ventricular rhythm, valvular regurgitation and neurohormonal effects. Treatment includes correction of neurohumoral activation, prevention of thromboembolism, maintenance of sinus rhythm, and pharmacologic and interventional control of ventricular rate. The results of recent trials (PIAF-Pharmacological Intervention in Atrial Fibrillation, RACE-RAte Control versus Electrical cardioversion for persistent atrial fibrillation, AFFIRM-Atrial Fibrillation Follow-up Investigation of Rhythm Management) suggest that a rate control strategy can be better than rhythm control, particularly in patients at high risk of relapse, like those with left ventricular dysfunction.
Scardi
Sabino
S
Centro Cardiovascolare Azienda Sanitaria Triestina Via Farneto, 3 34100 Trieste. sabino.scardi@assl.sanita.fvg.it
Mazzone
Carmine
C
D001281:Atrial Fibrillation / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans