Management of atrial fibrillation in patients with heart failure.
Atrial fibrillation is a marker for worse outcomes in patients with heart failure and requires careful, individualized management. Anticoagulation and rate control are important. Routine use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation for maintaining sinus rhythm is feasible for some patients, but further studies are needed to define the risks and benefits. A role remains for AV junction ablation and pacing, with consideration of biventricular pacing to prevent dyssynchrony induced by chronic right ventricular pacing. Ongoing trials will continue to define the risks and benefits as these therapies evolve.
Stevenson
William G
WG
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. wstevenson@partners.org
Tedrow
Usha
U
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017115:Catheter Ablation; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D006801:Humans
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents