HEART-FAILURE AND ATRIAL-FIBRILLATION - CURRENT CONCEPTS AND CONTROVERSIES

Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often pr esent in the same patient. In addition, there is increasing evidence o f a complex, reciprocal relation between heart failure and atrial fibr illation. Thus heart failure may cause atrial fibrillation, with elect romechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart fa ilure; in particular, when there is an uncontrolled ventricular rate, tachycardiomyopathy may develop and thereby heart failure. Eventually, a vicious circle between heart failure and atrial fibrillation may fo rm, in which neurohumoral activation and subtle derangement of rate co ntrol are involved. Treatment should aim at unloading of the heart, ad equate control of ventricular rate, and correction of neurohumoral act ivation. Angiotensin converting enzyme inhibitors may help to achieve these goals. Treatment should also include an attempt to restore sinus rhythm through electrical cardioversion, though appropriate timing of cardioversion is difficult. His bundle ablation may be used to achiev e adequate rate control in drug refractory cases.