Atrial Fibrillation in the Failing Heart – A Clinical Review
will be pivotal in terms of defining the place of AF ablation in patients suffering with LV dysfunction.
Conclusion
AF and HF are two disease conditions associated with increased morbidity and decreased survival. Treatment options focus on prevention of thromboembolism, rate control and rhythm maintenance. Anti-arrhythmic medications maintain sinus rhythm <50% with significant adverse side effects, including increased mortality, which may negate the positive effects of sinus rhythm. In recalcitrant rate-control AF patients, AV node ablation with biventricular pacing is an effective therapy in HF patients and appears to be more
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beneficial than RV pacing alone. Radiofrequency catheter ablation of AF shows great promise in restoring sinus rhythm without dependency on anti-arrhythmic therapy. Several studies using catheter ablation for rhythm control have consistently demonstrated an improvement in LV function, a decreased need for anti-arrhythmic therapy, improved quality of life measures and an increase in exercise tolerance. Staging AF patients with DE-MRI is a novel imaging modality that non-invasively quantifies the degree of structural remodelling in the LA and can determine whether patients are appropriate candidates for ablation. The future of rate versus rhythm control using AF ablation will be clarified by the highly anticipated results of the CASTLE-AF trial.60
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