From the Guidelines
Atrial fibrillation (AFib) is strongly associated with an increased risk of heart failure (HF), with a complex relationship between the two conditions [ 1 ].
Key Points
- AFib is a risk factor for developing HF, and patients with HF are more likely to develop AFib over time [ 1 ].
- The prevalence of AFib among patients with HF is between 10-57%, depending on age, onset, and severity of HF [ 1 ].
- AFib can lead to tachycardiomyopathy, a reversible cause of HF, particularly in patients with rapid ventricular response [ 1 ].
- Rhythm control may be beneficial in patients with AFib and HF, particularly in those with reversible secondary causes of AFib or refractory symptoms [ 1 ].
- Rate control is also important in managing AFib and HF, with a goal of achieving a heart rate between 60-100 beats per minute [ 1 ].
Management
- Beta-blockers are recommended as first-line rate-control medication, with digoxin as an adjunctive medication [ 1 ].
- Catheter ablation may be considered in patients with AFib and HF who are refractory to medical therapy [ 1 ].
Prognosis
- AFib is associated with an increased long-term risk of stroke, HF, and all-cause mortality, particularly among women [ 1 ].
- The mortality rate of patients with AFib is about double that of patients in normal sinus rhythm, linked to the severity of underlying heart disease [ 1 ].
From the Research
Relationship Between Atrial Fibrillation and Heart Failure
The relationship between atrial fibrillation (AFib) and heart failure is complex and bidirectional, with each condition influencing the other [(2,3,4,5,6)].
- Atrial fibrillation and heart failure share common risk factors and can exacerbate each other [(3,4,5)].
- Heart failure is a risk factor for atrial fibrillation, and atrial fibrillation is a risk factor for heart failure 3.
- The mechanisms underlying this association are not fully understood but are thought to involve heart failure-induced atrial fibrosis and atrial ionic remodeling 5.
Clinical Implications
- Atrial fibrillation is associated with a higher-risk baseline clinical status and higher mortality rates in patients with heart failure 5.
- Therapeutic considerations for atrial fibrillation in patients with heart failure include risk factor modification, guideline-directed medical therapy, anticoagulation, rate control, and rhythm control [(5,6)].
- The decision between a rate-control or rhythm-control strategy is evolving, with recent data suggesting that rhythm control, particularly through catheter ablation, may be associated with improved outcomes [(5,6)].
Pathophysiology
- Atrial fibrillation and heart failure frequently coexist and are associated with a significant increase in morbidity and mortality 4.
- The pathophysiologic relationship between atrial fibrillation and heart failure involves the interaction between atrial fibrillation and the two most common types of heart failure syndromes: HF with reduced ejection fraction and HF with preserved ejection fraction 4.