London Heart Rhythm Program, Western University, London, Ontario, Canada.
London Heart Rhythm Program, Western University, London, Ontario, Canada.
Can J Cardiol. 2018 Nov;34(11):1437-1448. doi: 10.1016/j.cjca.2018.07.483. Epub 2018 Aug 20.
Heart failure (HF) and atrial fibrillation (AF) share common risk factors and frequently coexist. Both are highly prevalent in our aging population, and mortality associated with the combination is significantly higher than for each alone. An intricate link exists between AF and HF, including interrelated mechanisms and pathophysiology. Asymptomatic left ventricular systolic or diastolic dysfunction can exacerbate or be exacerbated by AF, resulting in HF with reduced ejection fraction or preserved ejection fraction. A number of treatment strategies have improved symptoms, exercise tolerance, and quality of life for patients with HF, but few have resulted in alteration in prognosis. Sinus rhythm, achieved pharmacologically, has not altered important outcomes, including cardiovascular or total mortality in patients with HF. In recent studies, catheter ablation to achieve sinus rhythm seems to have a significant impact on symptoms, heart function, and possibly mortality. Until future studies can confirm or clarify the impact of catheter ablation on outcomes, the field remains cautious but optimistic that better treatment strategies for patients with HF with reduced ejection fraction or preserved ejection fraction are within reach.
心力衰竭 (HF) 和心房颤动 (AF) 有共同的危险因素，并且经常同时存在。两者在我们的老龄化人口中患病率都很高，并且与两者单独存在相比，联合存在的死亡率显著更高。AF 和 HF 之间存在复杂的联系，包括相互关联的机制和病理生理学。无症状的左心室收缩或舒张功能障碍可加重或由 AF 加重，导致射血分数降低或射血分数保留的 HF。许多治疗策略已改善 HF 患者的症状、运动耐量和生活质量，但很少有策略能改变预后。通过药理学手段实现窦性心律并未改变重要结局，包括 HF 患者的心血管或全因死亡率。在最近的研究中，导管消融术以实现窦性心律似乎对症状、心脏功能，甚至可能的死亡率有重大影响。在未来的研究能够证实或阐明导管消融术对结局的影响之前，该领域仍然持谨慎但乐观的态度，认为改善射血分数降低或射血分数保留的 HF 患者的治疗策略即将实现。
