Atrial Fibrillation Ablation and Heart Failure

Abstract

Atrial fibrillation (AF) worsens outcome in patients with systolic heart failure and the presence of heart failure (HF) predicts a 5- to 6-fold increase in risk of AF. In addition to loss of atrial systole, AF may contribute to left ventricular (LV) systolic dysfunction due a rapid ventricular rate, irregularity of rhythm and exacerbation of mitral regurgitation due to atrial dilatation. Elimination of atrial fibrillation with catheter ablation can improve ejection fraction and reduce heart failure symptoms and appears superior to AV node ablation and bi-ventricular pacing. AF ablation can restore sinus rhythm in most patients with heart failure. Additional study is warranted to identify which patients will receive maximum benefit from aggressive rhythm control and to determine efficacy in patients with diastolic heart failure.