disease interaction(s) of atrial fibrillation with heart failure
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Clinical significance
- coexistence is associated with adverse prognosis[1]
- patients with heart failure & atrial fibrillation do not benefit as much from beta-blocker as those in sinus rhythm
- lower heart rates are associated with better outcomes in patients with heart failure in sinus rhythm[3]
- lower heart rates are not associated with better outcomes in patients with heart failure & atrial fibrillation[3]
- in patients with heart failure & atrial fibrillation, beta-blocker therapy reduced mortality (RR = 0.86) but not hospitalizations[2]
- in patients with heart failure in sinus rhythm, beta-blocker therapy reduced mortality (RR = 0.63) & reduced hospitalizations[2]
- beta-blockers do not diminish mortality or hospitalization in patients with heart failure & atrial fibrillation[4]
- however, they may do no harm[4]
Management
- rate control is preferred over rhythm control[1]
- catheter-ablation may be an option
- catheter ablation for atrial fibrillation in patients with left ventricular systolic dysfunction reduces mortality & hospitalization for worsening heart failure[5]
- catheter ablation improves clinical outcomes, including all-cause mortality, in patients with heart failure referred for heart transplantation evaluation[6]
- also see atrial fibrillation
More general terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Deedwania PC, Lardizabal JA. Atrial fibrillation in heart failure: a comprehensive review. Am J Med. 2010 Mar;123(3):198-204. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20193823
- ↑ Jump up to: 2.0 2.1 2.2 Rienstra M et al Beta-Blockers and Outcome in Heart Failure and Atrial Fibrillation. JACC Heart Fail. 2013;1(1):21-28 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24632222 <Internet> http://heartfailure.onlinejacc.org/article.aspx?articleid=1568318
Bristow MR and Aleong RG Treatment of the Heart Failure Patient With Atrial Fibrillation. A Major Unmet Need. JJACC Heart Fail. 2013;1(1):29-30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24621796 <Internet> http://heartfailure.onlinejacc.org/article.aspx?articleid=1568319 - ↑ Jump up to: 3.0 3.1 3.2 Cullington D et al. Is heart rate important for patients with heart failure in atrial fibrillation? JACC Heart Fail 2014 Jun; 2:213 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24952686
- ↑ Jump up to: 4.0 4.1 4.2 Kotecha D et al. Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: An individual-patient data meta-analysis. Lancet 2014 Sep 2; PMID: https://www.ncbi.nlm.nih.gov/pubmed/25193873
- ↑ Jump up to: 5.0 5.1 Marrouche NF, Brachmann J, Andresen D et al Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 378:417-427. Feb 1, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29385358 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1707855
Link MS. Paradigm Shift for Treatment of Atrial Fibrillation in Heart Failure. N Engl J Med 2018; 378:468-469. Feb 1, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29385377 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1714782 - ↑ Jump up to: 6.0 6.1 Sohns C et al. for the CASTLE HTx Investigators. Catheter ablation in end-stage heart failure with atrial fibrillation. N Engl J Med 2023 Aug 27; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37634135 https://www.nejm.org/doi/10.1056/NEJMoa2306037