Rate Versus Rhythm Control in Heart Failure Patients with Post-Operative Atrial Fibrillation After Cardiac Surgery

2021 ◽  
Vol 27 (8) ◽  
pp. 915-919
Author(s):  
Eunice Yang ◽  
David Spragg ◽  
Steven Schulman ◽  
Nisha A. Gilotra ◽  
Ahmet Kilic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Rhythm Control ◽  
Heart Failure Patients ◽  
Post Operative Atrial Fibrillation ◽  
Rate Versus

RATE VERSUS RHYTHM CONTROL OF ATRIAL FIBRILLATION AFTER CARDIAC SURGERY IN PATIENTS WITH HEART FAILURE

2020 ◽  
Vol 75 (11) ◽  
pp. 402
Author(s):  
Eunice Yang ◽  
David Spragg ◽  
Steven P. Schulman ◽  
Glenn Whitman ◽  
Thomas S. Metkus
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Rhythm Control ◽  
Rate Versus ◽  
Patients With Heart Failure

scholarly journals Early Rhythm Control Therapy in Patients with Atrial Fibrillation and Heart Failure

Circulation ◽  
2021 ◽  
Author(s):  
Andreas Rillig ◽  
Christina Magnussen ◽  
Ann-Kathrin Ozga ◽  
Anna Suling ◽  
Axel Brandes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Control Therapy

Background: Even on optimal therapy, many patients with heart failure and atrial fibrillation experience cardiovascular complications. Additional treatments are needed to reduce these events, especially in patients with heart failure and preserved left ventricular ejection fraction (HFpEF). Methods: This prespecified subanalysis of the randomized EAST - AFNET 4 trial assessed the effect of systematic, early rhythm control therapy (ERC; using antiarrhythmic drugs or catheter ablation) compared to usual care (UC, allowing rhythm control therapy to improve symptoms) on the two primary outcomes of the trial and on selected secondary outcomes in patients with heart failure, defined as heart failure symptoms NYHA II-III or left ventricular ejection fraction [LVEF] <50%. Results: This analysis included 798 patients (300 (37.6%) female, median age 71.0 [64.0, 76.0] years, 785 with known LVEF). The majority of patients (n=442) had HFpEF (LVEF≥50%; mean LVEF 61% ± 6.3%), the others had heart failure with mid-range ejection fraction (n=211; LVEF40-49%; mean LVEF 44% ± 2.9%) or heart failure with reduced ejection fraction (n=132; LVEF<40%; mean LVEF 31% ± 5.5%). Over the 5.1-year median follow-up, the composite primary outcome of cardiovascular death, stroke or hospitalization for worsening of heart failure or for acute coronary syndrome occurred less often in patients randomized to ERC (94/396; 5.7 per 100 patient-years) compared with patients randomized to UC (130/402; 7.9 per 100 patient-years; hazard ratio 0.74 [0.56-0.97], p=0.03), not altered by heart failure status (interaction p-value=0.63). The primary safety outcome (death, stroke, or serious adverse events related to rhythm control therapy) occurred in 71/396 (17.9%) heart failure patients randomized to ERC and in 87/402 (21.6%) heart failure patients randomized to UC (hazard ratio 0.85 [0.62-1.17], p=0.33). LV ejection fraction improved in both groups (LVEF change at two years: ERC 5.3%±11.6%, UC 4.9%±11.6%, p=0.43). ERC also improved the composite outcome of death or hospitalization for worsening of heart failure. Conclusions: Rhythm control therapy conveys clinical benefit when initiated within one year of diagnosing atrial fibrillation in patients with signs or symptoms of heart failure. Clinical Trial Registration: Unique Identifiers: ISRCTN04708680, NCT01288352, EudraCT2010-021258-20, Study web site www.easttrial.org; URLs: www.controlled-trials.com; https://clinicaltrials.gov; https://www.clinicaltrialsregister.eu

scholarly journals Rhythm Control in Heart Failure Patients With Atrial Fibrillation

2014 ◽  
Vol 64 (7) ◽  
pp. 710-721 ◽  
Author(s):  
Kevin M. Trulock ◽  
Sanjiv M. Narayan ◽  
Jonathan P. Piccini
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Rhythm Control ◽  
Heart Failure Patients

The Role of Atrial Fibrillation among Patients with Chronic Heart Failure

2020 ◽  
Vol 4 (53) ◽  
pp. 13-18
Author(s):  
Katarzyna Przybylska-Siedlecka ◽  
Wiktoria Kowalska ◽  
Michał Mazurek ◽  
Oskar Kowalski
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Control Strategy ◽  
Rate Control ◽  
Rhythm Control ◽  
Atrial Fibrillation Ablation ◽  
Cardioverter Defibrillator ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Worse Prognosis

Both heart failure and atrial fibrillation are significant health problems affecting approximately 1-2% of the adult population. Atrial fibrillation (AF) increases the incidence of thromboembolic complications, increases the frequency of hospitalization, morbidity due to heart failure, and is an independent risk factor for death. AF is the most common arrhythmia occurring in patients with heart failure. Patients with heart failure and implantable devices Atrial fibrillation with rapid ventricular response remains one of the most common causes of inadequate interventions of implanted cardioverter-defibrillator (ICD) or resynchronization systems with cardioverter-defibrillator function (CRT-D). Both AF and inadequate interventions are strongly associated with worse prognosis and increased risk of all-cause death. Furthermore, in presence of multiple inapproriate shocks the patients’ prognosis worsens. Thus they require more frequent interventions most frequently reprogramming of the device, modification of pharmacotherapy and correction of accompanying irregularities such as electrolyte disturbances. AF is also a major cause of loss of biventricular pacing in patients with an implanted resynchronizing system, which leads into an exacerbation of heart failure symptoms, an increase in hospitalization and mortality. No clear advantage has been demonstrated for rate or rhythm control strategy for survival in patients with AF. In the European registry EORP-AF a higher mortality rate was observed in the group treated with rate control strategy. However, after considering the effects of associated diseases, the difference in mortality among patients undergoing rhythm control and rate control was not statistically significant. Recently, several studies comparing antiarrhythmic therapy with atrial fibrillation ablation have been published. The article briefly discusses some of them, such as the CASTLE-AF study, AATAC, CAMERA-MRI, the CABANA study. Despite the different results of these studies, reports on the effectiveness of atrial fibrillation ablation among patients with heart failure are promising. According to updated guidelines of American cardiology societies from 2019, ablation of atrial fibrillation can be considered in patients with symptomatic AF and heart failure with reduced left ventricular ejection fraction to reduce mortality and the frequency of hospitalization for heart failure. Patients with atrial fibrillation and heart failure have a worse prognosis than patients with heart failure and sinus rhythm. However, we can improve it by diagnosing atrial fibrillation and implementing adequate treatment, including invasive atrial fibrillation therapy.

scholarly journals ATRIAL FIBRILLATION AND CONGESTIVE HEART FAILURE: A COST ANALYSIS OF RATE VERSUS RHYTHM CONTROL STRATEGIES

2011 ◽  
Vol 57 (14) ◽  
pp. E1183
Author(s):  
Frédéric Poulin ◽  
Paul Khairy ◽  
Sylvie Lévesque ◽  
Denis Roy ◽  
Mario Talajic ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Cost Analysis ◽  
Control Strategies ◽  
Rhythm Control ◽  
Rate Versus

scholarly journals Atrial Fibrillation Ablation in Heart Failure Patients

2021 ◽  
Vol 10 (16) ◽  
pp. 3512
Author(s):  
Michael Derndorfer ◽  
Shaojie Chen ◽  
Helmut Pürerfellner
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Side Effects ◽  
Meta Analysis ◽  
Treatment Options ◽  
Rhythm Control ◽  
The Other ◽  
Heart Failure Patients

Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each other, as each can be either the cause of or the result of the other. Successfully treating one of the two entities means laying the basis for treating the other one as well. Management of patients with AF and HF can be challenging and should primarily adhere to available guidelines. Concerning AF, medication is limited and causes many side effects, leading to low medical adherence. Several smaller studies, summarized in a big meta-analysis, provide evidence that ablation of AF in HF patients is crucial for improving quality of life, reducing HF hospitalizations, and reducing death, provided the LVEF is at least 25% or higher. In advanced HF, alternative treatment options (including assist devices, heart transplant) might still be the better option. Early rhythm control should be taken into consideration, as there is evidence that it is associated with better cardiovascular outcome.

scholarly journals Update on management of atrial fibrillation in heart failure: a focus on ablation

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318081
Author(s):  
Bart A Mulder ◽  
Michiel Rienstra ◽  
Isabelle C Van Gelder ◽  
Yuri Blaauw
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Symptomatic Relief ◽  
Critical Evaluation ◽  
Rhythm Control ◽  
Rate Versus ◽  
Patients With Heart Failure ◽  
Post Hoc

Atrial fibrillation is increasingly encountered in patients with heart failure. Both diseases have seen tremendous rises in incidence in recent years. In general, the treatment of atrial fibrillation is focused on relieving patients from atrial fibrillation-related symptoms and risk reduction for thromboembolism and the occurrence or worsening of heart failure. Symptomatic relief may be accomplished by either (non-)pharmacological rate or rhythm control in combination with optimal therapy of underlying cardiovascular morbidities and risk factors. Atrial fibrillation ablation has been performed in patients without overt heart failure successfully for many years. However, in recent years, attempts have been made for patients with heart failure as well. In this review, we discuss the current literature describing the treatment of atrial fibrillation in heart failure. We highlight the early rate versus rhythm control studies, the importance of addressing underlying conditions and treatment of risk factors. A critical evaluation will be performed of the catheter ablation studies that have been performed so far in light of larger (post-hoc) ablation studies. Furthermore, we will hypothesise the role of patient selection as next step in optimising outcome for patient with atrial fibrillation and heart failure.

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