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.

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 Interleukin-6 Could Be a Potential Prognostic Factor in Ambulatory Elderly Patients with Stable Heart Failure: Results from a Pilot Study

2021 ◽  
Vol 10 (3) ◽  
pp. 504
Author(s):  
Marina Povar-Echeverría ◽  
Pablo Esteban Auquilla-Clavijo ◽  
Emmanuel Andrès ◽  
Francisco Javier Martin-Sánchez ◽  
María Victoria Laguna-Calle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Interleukin 6 ◽  
Kaplan Meier ◽  
Patients With Heart Failure ◽  
Potential Prognostic Factor ◽  
Fundamental Phenomenon ◽  
Group 2

Introduction: Inflammation is a fundamental phenomenon in heart failure, but the prognostic or therapeutic role of markers such as interleukin-6 (IL-6) has not yet been clarified. The objective of this study is to describe the clinical profile of patients with elevated IL-6 and determine if they have worse clinical outcomes. Methods: A retrospective c.ohort observational study including 78 patients with heart failure followed up at the Heart Failure Outpatient Clinic of the Internal Medicine Department. IL-6 was determined in all patients, who were then assigned into two groups according to IL-6 level (normal or high). Clinical and prognostic data were collected to determine the differences in both groups. Results: The average age was 79 years, 60% female. A total of 53.8% of the patients had elevated IL-6 (group 2). Patients with elevated IL-6 presented more frequently with anemia mellitus (64.3% vs. 41.7%; p = 0.046), atrial fibrillation (83.3% vs. 61.9% p = 0.036), dyslipidemia (76.2% vs. 58.2%; p = 0.03), higher creatinine levels (1.35 mg/dL vs. 1.08 mg/dL; p = 0.024), lower glomerular filtration rate (43.6 mL/min/m2 vs. 59.9 mL/min/m2; p = 0.007), and anemia 25% vs. 52.4% p = 0.014. The factors independently associated with the increase in IL-6 were anemia 3.513 (1.163–10.607) and renal failure 0.963 (0.936–0.991), p < 0.05. Mortality was higher in the group with elevated IL-6 levels (16% vs. 2%; p = 0.044) with a log-rank p = 0.027 in the Kaplan–Meier curve. Conclusion: Patients with heart failure and elevated IL-6 most often have atrial fibrillation, diabetes mellitus, dyslipidemia, anemia, and renal failure. In addition, mortality was higher and a tendency of higher hospital admission was observed in stable HF patients with elevated IL-6.

scholarly journals Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 11 (2) ◽  
pp. 288
Author(s):  
Emmanuel Androulakis ◽  
Catrin Sohrabi ◽  
Alexandros Briasoulis ◽  
Constantinos Bakogiannis ◽  
Bunny Saberwal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Ejection Fraction ◽  
Control Strategy ◽  
Meta Analysis ◽  
Rhythm Control ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure

Background: Catheter ablation (CA) for atrial fibrillation (AF) has been proposed as a means of improving outcomes among patients with heart failure and reduced ejection fraction (HFrEF) who are otherwise receiving appropriate treatment. Unlike HFrEF, treatment options are more limited in patients with preserved ejection fraction (HFpEF) and the data pertaining to the management of AF in these patients are controversial. The aim of this systematic review and meta-analysis was to investigate the effects of CA on outcomes of patients with AF and HFpEF, such as functional status, post-procedural complications, hospitalization, morbidity and mortality, based on data from observational studies. Methods: We systematically searched the electronic databases MEDLINE, PUBMED, EMBASE and the Cochrane Library for Central Register of Clinical Trials until May 2020. Results: Overall, the pooling of our data showed that sinus rhythm was achieved long-term in 58.0% (95% CI 0.44–0.71). Long-term AF recurrence was noticed in 22.3% of patients. Admission for HF occurred in 6.2% (95% CI 0.04–0.09) whilst all-cause mortality was identified in 6.3% (95% CI 0.02–0.13). Conclusion: This meta-analysis is the first to focus on determining the benefits of a rhythm control strategy for patients with AF and HFpEF using CA, suggesting it may be worthwhile to investigate the effects of a CA rhythm control strategy as the default treatment of AF in HFpEF patients in randomized trials.

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 The influence of atrial fibrillation on the levels of NT-proBNP versus GDF-15 in patients with heart failure

2019 ◽  
Vol 109 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Bernadet T. Santema ◽  
Michelle M. Y. Chan ◽  
Jasper Tromp ◽  
Martin Dokter ◽  
Haye H. van der Wal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Plasma Levels ◽  
Validation Cohort ◽  
Post Hoc Analysis ◽  
Patients With Heart Failure ◽  
History Of ◽  
Post Hoc ◽  
Multivariable Adjustment

Abstract Background In heart failure (HF), levels of NT-proBNP are influenced by the presence of concomitant atrial fibrillation (AF), making it difficult to distinguish between HF versus AF in patients with raised NT-proBNP. It is unknown whether levels of GDF-15 are also influenced by AF in patients with HF. In this study we compared the plasma levels of NT-proBNP versus GDF-15 in patients with HF in AF versus sinus rhythm (SR). Methods In a post hoc analysis of the index cohort of BIOSTAT-CHF (n = 2516), we studied patients with HF categorized into three groups: (1) AF at baseline (n = 733), (2) SR at baseline with a history of AF (n = 183), and (3) SR at baseline and no history of AF (n = 1025). The findings were validated in the validation cohort of BIOSTAT-CHF (n = 1738). Results Plasma NT-proBNP levels of patients who had AF at baseline were higher than those of patients in SR (both with and without a history of AF), even after multivariable adjustment (3417 [25th–75th percentile 1897–6486] versus 1788 [682–3870], adjusted p < 0.001, versus 2231 pg/mL [902–5270], adjusted p < 0.001). In contrast, after adjusting for clinical confounders, the levels of GDF-15 were comparable between the three groups (3179 [2062–5253] versus 2545 [1686–4337], adjusted p = 0.36, versus 2294 [1471–3855] pg/mL, adjusted p = 0.08). Similar patterns of both NT-proBNP and GDF-15 were found in the validation cohort. Conclusion These data show that in patients with HF, NT-proBNP is significantly influenced by underlying AF at time of measurement and not by previous episodes of AF, whereas the levels of GDF-15 are not influenced by the presence of AF. Therefore, GDF-15 might have additive value combined with NT-proBNP in the assessment of patients with HF and concomitant AF. Graphic abstract

The role of atrial fibrillation catheter ablation in patients with heart failure

2021 ◽  
Vol 66 ◽  
pp. 80-85
Author(s):  
Michael L. Bernard ◽  
Francis Benn ◽  
Cody M. Williams ◽  
A. Elise Hiltbold ◽  
Paul A. Rogers ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Patients With Heart Failure

scholarly journals Atrial fibrillation ablation in heart failure

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E50-E53
Author(s):  
Cristina Balla ◽  
Riccardo Cappato
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Control Strategy ◽  
Rate Control ◽  
Pharmacological Therapy ◽  
Rhythm Control ◽  
Invasive Approach ◽  
Normal Cardiac Function

Abstract Atrial fibrillation (AF) and heart failure (HF) commonly coexist in the same patient and either condition predisposes to the other. Several mechanisms promote the pathophysiological relationship between AF and HF, reducing quality of life, increasing the risk of stroke, and worsening HF progression. Although restoration and maintenance of sinus rhythm would be ideal for those patients, several trials comparing rhythm and rate control failed to show a benefit of rhythm control strategy, achieved with pharmacological therapy, in terms of hospitalization for HF or death. Catheter ablation is a well-established option for symptomatic AF patients, resistant to drug therapy, with normal cardiac function. Several recent studies have shown an improvement in clinical outcomes after AF ablation in HF patients highlighting the emerging role of the invasive approach in this subset of patients. However, several concerns regarding patients’ selection and standardization of the procedure still remain to be addressed.

scholarly journals Atrial Fibrillation Ablation in Patients with Heart Failure: One Size Does Not Fit All

2018 ◽  
Vol 7 (2) ◽  
pp. 84 ◽  
Author(s):  
Rahul K Mukherjee ◽  
Steven E Williams ◽  
Mark D O’Neill ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Rate Control ◽  
State Of The Art ◽  
Previous Treatment ◽  
Rhythm Control ◽  
Patient Specific ◽  
Limited Efficacy ◽  
Patients With Heart Failure

Atrial fibrillation (AF) is common in patients with heart failure and is associated with poorer clinical outcomes compared with patients with heart failure alone. Recent evidence has challenged previous treatment paradigms in which rate control was considered equivalent to rhythm control in this population. Catheter ablation has emerged as a safe and effective treatment strategy in selected patients and overcomes the issues of limited efficacy and drug toxicities associated with pharmacological rhythm control. Numerous studies have explored the benefits of catheter ablation in patients with heart failure, but these have included heterogeneous patient cohorts and variable ablation strategies. This state-of-the-art review explores the evidence from these trials and examines the need for tailored, patient-specific strategies for AF ablation in patients with heart failure.

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.

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