Treatment for atrial fibrillation depends on the type of heart failure

When heart failure (HF) and atrial fibrillation (AF) are combined, cardiac ejection fraction should be considered in treatment. The observed trend suggests the influence of the type of heart failure on the choice of optimal therapy.

Treatment strategies for patients with HF and AF that focus on rate control with catheter ablation or rate control with medications or a pacemaker do not show significant differences in mortality or progression of HF. This was the claim made by a new study presented at the 70th annual scientific session of the American College of Cardiology (ACC).

The authors noted that the study was stopped early and therefore has limited statistical power to detect differences between the two treatment approaches. But the observed trend suggests the influence of the type of heart failure on the choice of the optimal treatment approach.

Atrial fibrillation, or AF, is one of the most common heart rhythm disorders and is often combined with HF, which seriously worsens the prognosis for patients with this diagnosis. Scientists have long been trying to figure out whether treatment should focus on controlling heart rate or reducing heart rate.

The new study included 411 patients at 21 medical centers in Canada, Brazil, Sweden and Taiwan and was the first to include participants with AF and HF. Reduced ejection fraction was observed in 171 patients, and preserved ejection fraction was observed in 240. The average age of the participants was 67 years, three quarters were men.

Half of the patients were treated with a focus on heart rate control, the other half with a focus on heart rate. To control heart rhythm, catheter ablation was used – a procedure to irreversibly destroy pathological sources of electrical signals in the heart. To control heart rate, patients received drug therapy. If drug treatment was ineffective, the atrioventricular node was destroyed, followed by implantation of a pacemaker.

According to the study’s lead author, Prof. Anthony Tenga (Antony Tang), ablative rhythm control reduces primary outcome measures as well as secondary outcomes of quality of life and markers of heart failure in patients with heart failure with reduced ejection fraction. Although the sample size was small and underrepresentative, the rate control strategy was less suitable for patients with HF with preserved ejection fraction, the study authors concluded.

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