Department of Internal Medicine, Electrophysiology Section, Division of Cardiology, University of California, San Francisco, San Francisco, California.
Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
Curr Opin Cardiol. 2020 May;35(3):271-275. doi: 10.1097/HCO.0000000000000734.
Atrial arrhythmias are common among individuals with heart failure with a reduced ejection fraction (HFrEF). This review describes management options for these arrhythmias and discusses emerging clinical data supporting catheter ablation.
Several recent clinical trials indicate that catheter ablation is superior to pharmacologic therapy for management of symptomatic atrial fibrillation in the setting of HFrEF. Restoration and maintenance of sinus rhythm appears to have the greatest benefit with regard to ejection fraction improvement among individuals with a nonischemic heart failure etiology and minimal left ventricular fibrosis.
A rhythm control strategy should be strongly considered in patients with HFrEF, especially when the atrial arrhythmia is symptomatic or is present at the time of a heart failure diagnosis. Catheter ablation may be the preferred strategy for maintenance of sinus rhythm in this patient population.
射血分数降低的心力衰竭（HFrEF）患者常发生房性心律失常。本文介绍了这些心律失常的治疗选择，并讨论了支持导管消融的新临床数据。
几项最近的临床试验表明，在 HFrEF 中，导管消融在管理有症状的心房颤动方面优于药物治疗。对于非缺血性心力衰竭病因和左心室纤维化最小的患者，恢复和维持窦性心律对射血分数的改善有最大的益处。
对于 HFrEF 患者，应强烈考虑节律控制策略，尤其是当房性心律失常有症状或在心力衰竭诊断时存在时。对于该患者人群，导管消融可能是维持窦性心律的首选策略。
