Optimizing therapy in patients with atrial fibrillation and heart failure

Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is expected to increase in the coming years. The same is true for heart failure. Atrial fibrillation may result in heart failure, and vice versa, but they can also exacerbate each other. The combination of atrial fibrillation and heart failure has important therapeutic implications to treat both diseases and create optimal outcomes for these patients.We started with patients with permanent atrial fibrillation. These patients are treated with frequency control, which means that the effect of treatment is only on the frequency of the heartbeat. We found that in patients with heart failure and preserved ejection fraction that lenient rate control did not lead to a worse outcome compared to strict (under 80 beats per minute) rate control.Then we will discuss pharmacological options: digoxin and beta-blockers. Digoxin is one of the oldest drugs in cardiology. In a well-validated patient population with permanent atrial fibrillation is it was investigated whether digoxin influences outcome. We were not able to find it. Beta-blockers are important in the treatment of heart failure. Large randomized studies have shown that it improves survival and reduces admissions for heart failure in sinus rhythm. It turned out that the effect of beta-blockers in patients with atrial fibrillation was not the same in comparison with patients in sinus rhythm. This effect was confirmed by means of a meta-analysis.We have looked at prognosis and found that total duration of atrial fibrillation since the beginning, NT-proBNP and Hs-Trop T. These three parameters were found to be excellent predictors of different outcomes in patients with permanent atrial fibrillationFinnaly patients were studied who received a special pacemaker which is intended to improve the prognosis of severe heart failure, known as cardiac resynchronization therapy (CRT). CRT also reduces hospitalizations for heart failure and a longer survival in patients with sinus rhythm. We found that patients with atrial fibrillation were of a similar outcome as compared to the patients with sinus rhythm. Survival for heart failure hospitalizations was also comparable between the two groups