Heart Failure and Atrial Fibrillation, Like Fire and Fury

JACC Heart Fail. 2019 Jun;7(6):447-456. doi: 10.1016/j.jchf.2019.03.005.

Abstract

Heart failure and atrial fibrillation are 2 common cardiovascular disorders that frequently complicate one another and exert a significant detrimental effect on cardiovascular health and well-being. Both heart failure and atrial fibrillation continue to increase in prevalence as the risk factors underlying each condition become more common. This review encompasses what is currently known about the epidemiology and pathophysiology of these comorbidities along with incorporation of landmark trials that have contributed to current guidelines. The focus is on clinically relevant considerations, including the contribution of inflammation in the pathophysiology of atrial fibrillation and heart failure. We explore the emerging role of catheter ablation relative to medical therapy in the management of heart failure with reduced ejection fraction, along with indications for biventricular pacing modalities in cardiac resynchronization therapy. We discuss current guideline-directed therapies and how practice models and national recommendations will likely change based on the most recent randomized controlled trials.

Keywords: atrial fibrillation; catheter ablation; heart failure; rate control; rhythm control.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use*
  • Anticoagulants / therapeutic use*
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / therapy*
  • Atrial Remodeling / physiology
  • Calcium Channel Blockers / therapeutic use
  • Cardiac Glycosides / therapeutic use
  • Cardiac Resynchronization Therapy*
  • Catheter Ablation*
  • Heart Failure / complications
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Humans
  • Inflammation / physiopathology
  • Ventricular Remodeling / physiology

Substances

  • Adrenergic beta-Antagonists
  • Anti-Arrhythmia Agents
  • Anticoagulants
  • Calcium Channel Blockers
  • Cardiac Glycosides