Management of Atrial Fibrillation in Patients With Heart Failure

BackgroundThere is a well-documented relationship and a complex interaction between atrial fibrillation (AF) and heart failure. The coexistence of these 2 clinical entities renders their management even more challenging.Methods and resultsWe searched current literature to review the management of AF in patients with heart failure. The cornerstones of AF treatment are rate control, cardioversion, and maintenance of sinus rhythm (SR), and prevention of thromboembolism. The issue of rhythm versus rate control remains unresolved. Nonpharmacologic therapies such as radiofrequency catheter ablation of the atrioventricular node with permanent pacemaker implantation, curative catheter ablation of AF, and cardiac resynchronization therapy are emerging and may alter the management of these patients.ConclusionTreatment of atrial fibrillation in the setting of heart failure encompasses a variety of approaches including drugs, devices, and ablation. Larger randomized trials are required to clarify the management of such patients.