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Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot

Atrial fibrillation (AF) and heart failure (HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the manag...

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Autores principales: Javed, Saad, Koniari, Ioanna, Fox, David, Skene, Chris, Lip, Gregory YH, Gupta, Dhiraj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100431/
https://www.ncbi.nlm.nih.gov/pubmed/33995509
http://dx.doi.org/10.11909/j.issn.1671-5411.2021.04.002
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author Javed, Saad
Koniari, Ioanna
Fox, David
Skene, Chris
Lip, Gregory YH
Gupta, Dhiraj
author_facet Javed, Saad
Koniari, Ioanna
Fox, David
Skene, Chris
Lip, Gregory YH
Gupta, Dhiraj
author_sort Javed, Saad
collection PubMed
description Atrial fibrillation (AF) and heart failure (HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF (Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.
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spelling pubmed-81004312021-05-14 Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot Javed, Saad Koniari, Ioanna Fox, David Skene, Chris Lip, Gregory YH Gupta, Dhiraj J Geriatr Cardiol Review Atrial fibrillation (AF) and heart failure (HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF (Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing. Science Press 2021-04-28 /pmc/articles/PMC8100431/ /pubmed/33995509 http://dx.doi.org/10.11909/j.issn.1671-5411.2021.04.002 Text en Copyright and License information: Journal of Geriatric Cardiology 2021 https://creativecommons.org/licenses/by-nc-sa/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ (https://creativecommons.org/licenses/by-nc-sa/4.0/)
spellingShingle Review
Javed, Saad
Koniari, Ioanna
Fox, David
Skene, Chris
Lip, Gregory YH
Gupta, Dhiraj
Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title_full Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title_fullStr Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title_full_unstemmed Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title_short Catheter ablation for atrial fibrillation in heart failure: untying the Gordian knot
title_sort catheter ablation for atrial fibrillation in heart failure: untying the gordian knot
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100431/
https://www.ncbi.nlm.nih.gov/pubmed/33995509
http://dx.doi.org/10.11909/j.issn.1671-5411.2021.04.002
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