Management of atrial fibrillation in heart failure

Abstract Heart failure and atrial fibrillation are two important epidemics in cardiovascular medicine. The two conditions often coexist. The ESC guidelines for atrial fibrillation provide a pathway to guide diagnosis and treatment of the condition. The cornerstones of atrial fibrillation treatment remain oral anticoagulation according to the CHA2DS2-VASc Score and identification and treatment of concomitant cardiovascular conditions, including heart failure. Rhythm control therapy is currently recommended to improve atrial fibrillation -related symptoms. Especially in patients with atrial fibrillation and heart failure, rhythm control therapy can have important impact on other outcomes, including heart failure progression and death. The recently published EAST-AFNET 4 trial emphasizes the necessity of early rhythm control in atrial fibrillation patients to reduce cardiovascular events. The heart failure sub-analysis and the heart failure sub-analysis of the CABANA trial both underpin that rhythm control therapy can prevent atrial fibrillation -related complications, such as cardiovascular death, stroke, and hospitalization for heart failure in patients with atrial fibrillation and heart failure across the range of left ventricular ejection fractions. Thus, rhythm control therapy emerges as the default third pillar of therapy for patients with recently diagnosed atrial fibrillation and for those with both atrial fibrillation and heart failure.