Author + information
- Received October 22, 2018
- Revision received February 19, 2019
- Accepted March 12, 2019
- Published online May 27, 2019.
- Matthew A. Carlisle, MDa,
- Marat Fudim, MDa,b,
- Adam D. DeVore, MD, MHSa,b and
- Jonathan P. Piccini, MD, MHSa,b,∗ ()
- aDuke Center for Atrial Fibrillation, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Jonathan P. Piccini, Electrophysiology Section, Duke University Medical Center, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27710.
• Optimal treatment strategies for patients with HF and AF are unclear.
• Current rate and rhythm control pharmacotherapies present challenges; however, randomized trials of catheter ablation have been promising.
• Future research should focus on improving long-term outcomes in HF with AF and the effective primary prevention of HF in patients with AF.
Heart failure and atrial fibrillation are 2 common cardiovascular disorders that frequently complicate one another and exert a significant detrimental effect on cardiovascular health and well-being. Both heart failure and atrial fibrillation continue to increase in prevalence as the risk factors underlying each condition become more common. This review encompasses what is currently known about the epidemiology and pathophysiology of these comorbidities along with incorporation of landmark trials that have contributed to current guidelines. The focus is on clinically relevant considerations, including the contribution of inflammation in the pathophysiology of atrial fibrillation and heart failure. We explore the emerging role of catheter ablation relative to medical therapy in the management of heart failure with reduced ejection fraction, along with indications for biventricular pacing modalities in cardiac resynchronization therapy. We discuss current guideline-directed therapies and how practice models and national recommendations will likely change based on the most recent randomized controlled trials.
Dr. Fudim is supported by an American Heart Association grant 17MCPRP33460225 and NIH T32 post-doctoral training grant 5T32HL007101-42; and consults for Axon Therapies and Galvani. Dr. DeVore has received funding for clinical research from Akros Medical, the American Heart Association, Amgen, Intra-Cellular Therapies, Luitpold Pharmaceuticals, the NHLBI, Novartis, and the Patient-Centered Outcomes Research Institute; and serves as a consultant to Novartis. Dr. Piccini receives grants for clinical research from Abbott, American Heart Association, Boston Scientific, Gilead, Janssen Pharmaceuticals, NHLBI, and Philips; and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, Johnson & Johnson, LivaNova, Medtronic, Milestone, Oliver Wyman Health, Sanofi, Philips, and Up-to-Date. Dr. Carlisle has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received October 22, 2018.
- Revision received February 19, 2019.
- Accepted March 12, 2019.
- 2019 American College of Cardiology Foundation
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