Published online Jul 26, 2013. doi: 10.4330/wjc.v5.i7.215
Revised: June 6, 2013
Accepted: June 19, 2013
Published online: July 26, 2013
Processing time: 82 Days and 17.5 Hours
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radiofrequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in a variety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.
Core tip: Atrial fibrillation commonly coexists with heart failure and there is growing evidence that it confers an adverse prognostic impact on the natural course of the disease. This review analyses the demographics and relevant literature highlighting this impact as well as the effect of various therapeutic modalities in improving outcomes. Finally some of the future trends in this exciting cardiovascular discipline are discussed.