TY - JOUR
T1 - Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction
T2 - A Scientific Statement From the American Heart Association
AU - Gopinathannair, Rakesh
AU - Chen, Lin Y.
AU - Chung, Mina K.
AU - Cornwell, William K.
AU - Furie, Karen L.
AU - Lakkireddy, Dhanunjaya R.
AU - Marrouche, Nassir F.
AU - Natale, Andrea
AU - Olshansky, Brian
AU - Joglar, Jose A.
N1 - Funding Information:
NIH (PI on NIH R01 grants)†
Publisher Copyright:
© 2021 American Heart Association, Inc.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee's consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
AB - Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee's consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.
KW - AHA Scientific Statements
KW - anticoagulants
KW - atrial fibrillation
KW - catheter ablation
KW - heart failure
KW - quality of life
KW - ventricular dysfunction, left
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U2 - 10.1161/HAE.0000000000000078
DO - 10.1161/HAE.0000000000000078
M3 - Review article
C2 - 34129347
AN - SCOPUS:85108246120
SN - 1941-3149
VL - 14
SP - E000078
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 7
ER -