Abstract
Heart failure and atrial fibrillation are two inter-related conditions with similar
risk factors and pathophysiology. They both increase morbidity and mortality. Almost
all patients need rate control, preferentially with a beta blocker. The role of rhythm
control in atrial fibrillation patients with heart failure is unclear. Class I antiarrhythmic
agents and dronedarone are contraindicated in patients with heart failure. Amiodarone
is an option, however, a major limitation is frequent side effects. Smaller studies
demonstrating that catheter ablation of atrial fibrillation may play a role have been
published. However, larger studies demonstrating beneficial effects on mortality are
yet not available. Antithrombotic therapy is needed in almost all patients to prevent
thromboembolic complications.
Therapy of atrial fibrillation in patients with heart failure is a challenge. Therapeutic
decisions should be made on an individual patient basis and implies a careful benefit-risk
assessment.
