Congestive heart failure and atrial fibrillation: rhythm versus rate control.
BACKGROUND
The incidence both of heart failure and atrial fibrillation is steadily increasing in the United States' population, and these conditions frequently coexist in the same patient. It is likely that the onset of one of these disorders leads to the onset and propagation of the other through multiple mechanisms. Several studies have investigated the prognosis of patients with both conditions, but a definitive conclusion regarding outcomes such as mortality and quality of life has yet to be determined.


RESULTS
Evidence demonstrating the improvement of left ventricular function and other hemodynamic parameters with the restoration and maintenance of sinus rhythm does exist. beta-blockade, angiotensin-converting enzyme inhibition, and aldosterone antagonism have been shown to improve survival in patients with heart failure. However, the efficacy of these therapies in patients with coexisting atrial fibrillation has not been adequately assessed. Furthermore, these therapies do not directly address the issue of rhythm management. The use of several antiarrhythmic medications and device therapy is becoming more frequent in the management of this subset of patients. Recent investigations of antiarrhythmic treatment have assessed outcomes such as survival, quality of life, exercise tolerance, and maintenance of sinus rhythm. Data from these studies suggest that antiarrhythmic therapy may be efficacious in such patients. Device therapy is another alternative which has been demonstrated to be at least as beneficial as medical therapy.


CONCLUSIONS
Both retrospective and prospective studies of antiarrhythmic therapy and device therapy have demonstrated promising results. Several studies are ongoing and will provide more insight into the management of such patients.
Kareti
Kiran R
KR
Division of Cardiovascular Diseases, University of Florida, Jacksonville, FL 32209, USA.
Chiong
Jun R
JR
Hsu
Steve S
SS
Miller
Alan B
AB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D010138:Pacemaker, Artificial; D011379:Prognosis
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents