The Timing and Role of Atrial Fibrillation Ablation in Heart Failure Patients

AbstractPurpose of ReviewAtrial fibrillation (AF) and heart failure (HF) are cardiovascular disease epidemics with increasing prevalence worldwide. AF can either be a cause or consequence of cardiomyopathy and HF. Catheter ablation (CA) has been a proven therapy for symptomatic, medically refractory AF patients. The purpose of this review is to highlight the role as well as timing of CA in treating AF patients with HF.Recent FindingsMultiple randomized clinical trials in recent years have elegantly demonstrated the superiority of CA in improving survival, quality of life, ventricular function, and reduce hospitalizations, when compared to antiarrhythmic drugs, medical rate control, as well as AV nodal ablation and biventricular pacing, in patients with HF and cardiomyopathy. These data clearly show that restoration and maintenance of sinus rhythm in HF patients, when accomplished by CA, improves hard clinical endpoints in this complex population. A substantial reduction in AF burden, and not complete elimination, was strongly associated with better outcomes and suggests an occult ‘arrhythmia induced cardiomyopathy’. Long-term success rate of a single ablation procedure remains subpar, and additional procedures are often necessary to achieve durable rhythm control.SummaryCatheter ablation now occupies a central role in rhythm control of AF in HF patients and should be considered as a first-line therapy in these patients. More data is needed regarding optimal timing of CA i...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research