Icahn School of Medicine at Mount Sinai, Cardiovascular and Heart Rhythm Consultants, New York, New York, USA.
J Cardiovasc Electrophysiol. 2024 Mar;35(3):530-537. doi: 10.1111/jce.16021. Epub 2023 Aug 7.
A vast amount of now well-established clinical and epidemiological data indicates a close, interdependent, and symbiotic association between atrial fibrillation (AF) and heart failure (HF). Both AF and HF, when co-exist in a patient, have serious treatment and prognostic implications. Based on the prevailing knowledge of the topic, various societies have issued a number of guidelines regarding the management of patients with AF and HF. Overall, it is the rhythm control strategy that has shown beneficial effect over the rate control strategy with improvement in symptoms of AF and HF. While antiarrhythmic drugs (AADs) and catheter ablation (CA) may be utilized as rhythm control strategy for AF, both AADs and CA have limitations of their own. Furthermore, with the progress made in various pharmacotherapeutic agents in HF, one could question the utility of CA in HF (i.e., whether ablation is mandatory or pointless in patients who have HF). The purpose of this review is to discuss this very point, focusing on the beneficial, neutral, or detrimental outcome of CA based on the category and class of HF.
大量现已确立的临床和流行病学数据表明，心房颤动（AF）和心力衰竭（HF）之间存在密切、相互依存和共生的关系。当 AF 和 HF 在患者中同时存在时，会对治疗和预后产生严重影响。基于该主题的现有知识，各个协会已经发布了一些关于 AF 和 HF 患者管理的指南。总体而言，节律控制策略优于心率控制策略，可改善 AF 和 HF 的症状。虽然抗心律失常药物（AADs）和导管消融（CA）可作为 AF 的节律控制策略，但 AADs 和 CA 都有其自身的局限性。此外，随着 HF 中各种药物治疗的进展，人们可能会质疑 CA 在 HF 中的效用（即，在 HF 患者中消融是否是必需的或无意义的）。本综述的目的是讨论这一点，重点是根据 HF 的类别和分级，讨论 CA 的有益、中性或有害结果。
