title: Atrial fibrillation ablation and left appendage closure in heart failure patients.
abstract: OBJECTIVE
  Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk. Consequently, there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention. This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients.
  
  
  RESULTS
  Several randomized control trials and systematic reviews demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction. In multiple trials, these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function, quality of life, and clinical heart failure symptoms. The evidence of clinical benefit of atrial fibrillation ablation in heart failure patients with preserved ejection fraction remains limited. Only a handful of randomized controlled trials have been performed evaluating left atrial appendage closure, and there is insufficient data regarding the safety and efficacy of these procedures in heart failure patients.
  
  
  CONCLUSIONS
  Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure. There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction. Currently, there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients.
authors: From the Department of Medicine, Columbia University Medical Center, New York, New York, USA.
authors: Minesh R
authors: MR
authors: Patel
authors: Angelo B
authors: AB
authors: Biviano
mesh_terms: D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications*