Review Article | Published:

Comorbidity of atrial fibrillation and heart failure

Nature Reviews Cardiology volume 13, pages 131147 (2016) | Download Citation

Abstract

Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics, together responsible for substantial human suffering and health-care expenditure. Ageing, improved cardiovascular survival, and epidemiological transition form the basis for their increasing global prevalence. Although we now have a clear picture of how HF promotes AF, gaps remain in our knowledge of how AF exacerbates or even causes HF, and how the development of HF affects the outcome of patients with AF. New data regarding HF with preserved ejection fraction and its unique relationship with AF suggest a possible role for AF in its aetiology, possibly as a trigger for ventricular fibrosis. Deciding on optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of catheter ablation. Restoring sinus rhythm by catheter ablation seems successful in the medium term and improves HF symptoms, functional capacity, and left ventricular function. Long-term studies to examine the effect on rates of stroke and death are ongoing. Guidelines continue to evolve to keep pace with this rapidly changing field.

Key points

  • Patients with both atrial fibrillation (AF) and heart failure (HF) present unique diagnostic and management challenges

  • No randomized trial has demonstrated that pharmacological rhythm control confers a reduction in mortality compared with rate control in patients with both AF and HF

  • Studies of highly selected populations of patients with both AF and HF indicate that, in the short term, AF ablation improves symptoms of HF, functional capacity, and left ventricular function

  • Randomized, controlled trials to evaluate hard clinical outcomes of AF ablation in patients with both AF and HF are currently in progress

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Affiliations

  1. Department of Cardiovascular Medicine, University of Melbourne and The Alfred Hospital, Royal Parade, Melbourne, Victoria 3181, Australia.

    • Liang-Han Ling
    •  & Peter M. Kistler
  2. Department of Cardiology, University of Melbourne and Royal Melbourne Hospital, Royal Parade, Parkville, Melbourne, Victoria 3050, Australia.

    • Jonathan M. Kalman
  3. The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust & Queen Mary, University of London, Bartholomew Close, London EC1A 7BE, UK.

    • Richard J. Schilling
    •  & Ross J. Hunter

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L.-H.L. researched data for the article and wrote the manuscript. All the authors contributed to discussion of content and reviewed/edited the manuscript before submission.

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The authors declare no competing financial interests.

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Correspondence to Ross J. Hunter.

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