Atrial arrhythmias in heart failure with a reduced ejection fraction

Purpose of review Atrial arrhythmias are common among individuals with heart failure with a reduced ejection fraction (HFrEF). This review describes management options for these arrhythmias and discusses emerging clinical data supporting catheter ablation. Recent findings Several recent clinical trials indicate that catheter ablation is superior to pharmacologic therapy for management of symptomatic atrial fibrillation in the setting of HFrEF. Restoration and maintenance of sinus rhythm appears to have the greatest benefit with regard to ejection fraction improvement among individuals with a nonischemic heart failure etiology and minimal left ventricular fibrosis. Summary A rhythm control strategy should be strongly considered in patients with HFrEF, especially when the atrial arrhythmia is symptomatic or is present at the time of a heart failure diagnosis. Catheter ablation may be the preferred strategy for maintenance of sinus rhythm in this patient population.
Source: Current Opinion in Cardiology - Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

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Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age>75 years, diabetes mel...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research
The most common form of sustained cardiac arrhythmia, which is characterized by irregular heartbeats, is atrial fibrillation (AF). The maintenance of AF is mediated by changes in the atrial structural and electrical properties.1 AF is a major risk factor for ischemic stroke and heart failure,2,3 which are associated with enhanced morbidity, mortality, and socioeconomic burden.4 The prevalence of AF is estimated to markedly increase as the population ages. Therefore, it is important to elucidate the molecular mechanisms underlying AF.
Source: Heart and Lung - Category: Intensive Care Authors: Source Type: research
Abstract Atrial fibrillation (AF) represents the most common arrhythmia worldwide, and its prevalence exponentially increases with age. It is related to increased risk of ischemic stroke or systemic embolism, which determines a significant burden of morbidity and mortality, as widely documented in the literature. AF also constitutes a risk factor for other less investigated conditions, such as heart failure, pulmonary embolism, impairment in physical performance, reduced quality of life and development of disability, mood disorders, and cognitive impairment up to dementia. In the elderly population, the management...
Source: Ageing Research Reviews - Category: Genetics & Stem Cells Authors: Tags: Ageing Res Rev Source Type: research
AbstractPurpose of reviewIn this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure.Recent findingsWhile rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outc...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
AbstractAimsRight ventricular hypertrophy (RVH) is a common finding in Anderson –Fabry disease (AFD), but the prognostic role of right ventricular (RV) involvement has never been assessed. The aim of our study was to evaluate the prognostic significance of RVH and RV systolic function in AFD.Methods and resultsForty ‐five AFD patients (56% male patients) with extensive baseline evaluation, including assessment of RVH and RV systolic function, were followed‐up for an average of 51.2 ± 11.4 months. RV systolic function was assessed by standard and tissue Doppler echocardiography. Cardiovascula...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
IRVINE, CA – May 8, 2020 – Johnson &Johnson Medical Devices Companies* today announced that Biosense Webster, Inc.’s THERMOCOOL SMARTTOUCH® SF Ablation Catheter, evaluated in the PRECEPT study for the treatment of persistent atrial fibrillation (AF), resulted in freedom from any documented, symptomatic atrial arrhythmias at 15 months post-procedure for eight out of ten study participants (80.4 percent).1 Use of the THERMOCOOL SMARTTOUCH SF CATHETER for persistent atrial fibrillation is investigational only. This PRECEPT study data support a Premarket Approval supplement application to the U.S. Foo...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
DiscussionCurrent evidence supports renin –angiotensin–aldosterone system (RAAS) inhibition as an upstream therapy in AF management. Excess aldosterone secretion results in proarrhythmic effects. Among the RAAS inhibitors, only canrenone is administered intravenously. Canrenone additionally increases the plasma level of potassium, lower s blood pressure and reduces preload. It has been already used in primary and secondary hyperaldosteronism in the course of chronic liver dysfunction and in heart failure.Trial registrationClinicalTrials.gov,NCT03536806. Registered on 25 May 2018.
Source: Trials - Category: Research Source Type: clinical trials
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, and is associated with significant morbidity and mortality. A significant proportion of AF is asymptomatic but nevertheless carries important prognostic implications [1]. In order to be diagnosed with “clinical AF” a patient must have symptoms or have a high enough burden of AF to be documented by an electrocardiogram. Data monitoring of modern cardiac implanted electronic device (CIED) has enhanced diagnostic capability in comparison to conventional non-invasive detection method, and the opp ortunity to continuously detect...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
Conclusion: BA was successful in patients with AFL and septal VT resistant to standard ablation. Relapses of clinical arrhythmia are rare; however, long-term follow-up is complicated by recurrences of different arrhythmias related to complex arrhythmogenic substrate
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Trial/Experimental Study Source Type: research
Abstract Plasticity is a fundamental property of neurons in both the central and peripheral nervous systems, enabling rapid changes in neural network function. The intracardiac nervous system (ICNS) is an extensive network of neurons clustered into ganglionated plexi (GP) on the surface of the heart. GP neurons are the final site of neuronal control of heart rhythm, and pathophysiological remodeling of the ICNS is proposed to feature in multiple cardiovascular diseases including heart failure and atrial fibrillation. To examine the potential role of GP neuron plasticity in atrial arrhythmia and hypertension, we de...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
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