Atrial Fibrillation in Heart Failure: A Comprehensive Review
Abstract
Chronic heart failure and atrial fibrillation are 2 major disorders that are closely linked. Their coexistence is associated with adverse prognosis. Both share several common predisposing conditions, but their interaction involves complex ultrastructural, electrophysiologic, and neurohormonal processes that go beyond mere sharing of mutual risk factors. Rate control approach remains the standard therapy for atrial fibrillation in heart failure because current strategies at rhythm control have so far failed to positively impact mortality and morbidity. This is largely because of the shortcomings of current pharmacologic anti-arrhythmic agents. Surgical and catheter-based therapies are promising, but long-term data are lacking. The role of non-anti-arrhythmic therapeutic agents also is being explored. Further progress toward improved understanding the complex relationship between atrial fibrillation and heart failure should improve management strategies.
aDepartment of Medicine, University of California, San Francisco School of Medicine, San Francisco, Calif
bDepartment of Cardiology, Veterans Affairs Medical Center, Fresno, Calif
cDivision of Cardiology, University of California, San Francisco School of Medicine, Fresno Medical Education Program, Fresno
Requests for reprints should be addressed to Prakash C. Deedwania, MD, Division of Cardiology, VA Medical Center, 2615 E Clinton Avenue, Fresno, CA 93703
Funding: None.
Conflict of Interest: Dr Lardizabal does not have any relationship with industry and financial associations that might pose a conflict of interest. Dr Deedwania was a consultant and speaker and has been on the Advisory Board of Sanofi-Aventis.
Authorship: Both authors were significantly involved in all steps of the writing process, including the conception, design, drafting and critical revision of the manuscript, as well as final approval for its submission.
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