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.
