Atrial Fibrillation in Heart Failure: Should Catheter Ablation Play a Larger Role?
Heart failure (HF) promotes atrial fibrillation by contributing to electrical and structural changes. The development of atrial fibrillation in patients with pre-existing congestive heart failure (CHF) is associated with increased adverse events including heart failure progression and mortality.1,2 However, large randomized trials have failed to demonstrate that maintenance of sinus rhythm with antiarrhythmic drug therapy improves mortality.3 Some would argue that development of atrial fibrillation is a marker of deterioration and that therapy will have little benefit. Nonetheless, many would agree that sinus rhythm is a good thing. AF patients who have sinus rhythm restored have better functional capacity than those who remain in sinus rhythm.4 However, the electrophysiologic changes that accompany heart failure are likely to reduce the chances of long term maintenance of sinus rhythm. There is also concern that adverse effects of antiarrhythmic drugs, often amiodarone, in this population, offset the benefit of sinus rhythm. Achieving sinus rhythm with catheter ablation offers the potential to maintain sinus rhythm without offsetting adverse drug effects.
- Received March 24, 2016.
- Accepted March 28, 2016.