Atrial Fibrillation and Heart Failure: Rate Versus Rhythm Control



Atrial fibrillation and heart failure are commonly coexisting conditions with important pathophysiologic interactions impacting patient management. Treatment of atrial fibrillation with impaired ventricular function is focused towards preventing adverse hemodynamic effects that may result in more symptoms and decreased exercise tolerance. While rate control using medications or atrioventricular nodal ablation combined with pacing is the primary emphasis of management, rhythm control using pharmacologic or pulmonary vein isolation remains a feasible alternative strategy for some patients. The prevalence, mechanisms, and management strategies of atrial fibrillation and heart failure are reviewed in this chapter.


Heart Failure Atrial Fibrillation Cardiac Resynchronization Therapy Catheter Ablation Atrial Fibrillation Patient 
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  1. 1.
    Maisel WH, Stevenson LW (2003) Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 91(6A):2D–8DPubMedCrossRefGoogle Scholar
  2. 2.
    Tsang TS, Gersh BJ, Appleton CP, Tajik AJ, Barnes ME, Bailey KR, Oh JK, Leibson C, Montgomery SC, Seward JB (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol 40(9):1636–1644PubMedCrossRefGoogle Scholar
  3. 3.
    Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE (2001) Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 285(18):2370–2375PubMedCrossRefGoogle Scholar
  4. 4.
    Stewart S, Hart CL, Hole DJ, McMurray JJ (2001) Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study. Heart 86(5):516–521PubMedCrossRefGoogle Scholar
  5. 5.
    Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas PE, Widimsky P, Agladze V, Aliot E, Balabanski T, Blomstrom-Lundqvist C, Capucci A, Crijns H, Dahlof B, Folliguet T, Glikson M, Goethals M, Gulba DC, Ho SY, Klautz RJ, Kose S, McMurray J, Perrone Filardi P, Raatikainen P, Salvador MJ, Schalij MJ, Shpektor A, Sousa J, Stepinska J, Uuetoa H, Zamorano JL, Zupan I (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 12(10):1360–1420PubMedCrossRefGoogle Scholar
  6. 6.
    Wattigney WA, Mensah GA, Croft JB (2003) Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 108(6):711–716PubMedCrossRefGoogle Scholar
  7. 7.
    Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Rosamond WD, Sorlie PD, Stafford RS, Turan TN, Turner MB, Wong ND, Wylie-Rosett J (2011) Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation 123(4):e18–e209PubMedCrossRefGoogle Scholar
  8. 8.
    Shinbane JS, Wood MA, Jensen DN, Ellenbogen KA, Fitzpatrick AP, Scheinman MM (1997) Tachycardia-induced cardiomyopathy: a review of animal models and clinical studies. J Am Coll Cardiol 29(4):709–715PubMedCrossRefGoogle Scholar
  9. 9.
    Moe GW, Montgomery C, Howard RJ, Grima EA, Armstrong PW (1993) Left ventricular myocardial blood flow, metabolism, and effects of treatment with enalapril: further insights into the mechanisms of canine experimental pacing-induced heart failure. J Lab Clin Med 121(2):294–301PubMedGoogle Scholar
  10. 10.
    Spinale FG, Holzgrefe HH, Mukherjee R, Arthur SR, Child MJ, Powell JR, Koster WH (1995) LV and myocyte structure and function after early recovery from tachycardia-induced cardiomyopathy. Am J Physiol 268(2 Pt 2):H836–H847PubMedGoogle Scholar
  11. 11.
    Spinale FG, Hendrick DA, Crawford FA, Smith AC, Hamada Y, Carabello BA (1990) Chronic supraventricular tachycardia causes ventricular dysfunction and subendocardial injury in swine. Am J Physiol 259(1 Pt 2):H218–H229PubMedGoogle Scholar
  12. 12.
    O’Brien PJ, Ianuzzo CD, Moe GW, Stopps TP, Armstrong PW (1990) Rapid ventricular pacing of dogs to heart failure: biochemical and physiological studies. Can J Physiol Pharmacol 68(1):34–39PubMedCrossRefGoogle Scholar
  13. 13.
    Gaasch WH, Zile MR (1984) Evaluation of myocardial function in cardiomyopathic states. Prog Cardiovasc Dis 27(2):115–132PubMedCrossRefGoogle Scholar
  14. 14.
    Gillette PC, Smith RT, Garson A Jr, Mullins CE, Gutgesell HP, Goh TH, Cooley DA, McNamara DG (1985) Chronic supraventricular tachycardia. A curable cause of congestive cardiomyopathy. JAMA 253(3):391–392PubMedCrossRefGoogle Scholar
  15. 15.
    Packer DL, Bardy GH, Worley SJ, Smith MS, Cobb FR, Coleman RE, Gallagher JJ, German LD (1986) Tachycardia-induced cardiomyopathy: a reversible form of left ventricular dysfunction. Am J Cardiol 57(8):563–570PubMedCrossRefGoogle Scholar
  16. 16.
    Linderer T, Chatterjee K, Parmley WW, Sievers RE, Glantz SA, Tyberg JV (1983) Influence of atrial systole on the Frank-Starling relation and the end-diastolic pressure-diameter relation of the left ventricle. Circulation 67(5):1045–1053PubMedCrossRefGoogle Scholar
  17. 17.
    Cardin S, Li D, Thorin-Trescases N, Leung TK, Thorin E, Nattel S (2003) Evolution of the atrial fibrillation substrate in experimental congestive heart failure: angiotensin-dependent and -independent pathways. Cardiovasc Res 60(2):315–325PubMedCrossRefGoogle Scholar
  18. 18.
    Tisdale JE, Borzak S, Sabbah HN, Shimoyama H, Goldstein S (2006) Hemodynamic and neurohormonal predictors and consequences of the development of atrial fibrillation in dogs with chronic heart failure. J Card Fail 12(9):747–751. doi: S1071-9164(06)00859-1 PubMedCrossRefGoogle Scholar
  19. 19.
    Wasmund SL, Li JM, Page RL, Joglar JA, Kowal RC, Smith ML, Hamdan MH (2003) Effect of atrial fibrillation and an irregular ventricular response on sympathetic nerve activity in human subjects. Circulation 107(15):2011–2015PubMedCrossRefGoogle Scholar
  20. 20.
    Cha YM, Dzeja PP, Shen WK, Jahangir A, Hart CY, Terzic A, Redfield MM (2003) Failing atrial myocardium: energetic deficits accompany structural remodeling and electrical instability. Am J Physiol Heart Circ Physiol 284(4):H1313–H1320PubMedGoogle Scholar
  21. 21.
    Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100(1):87–95PubMedCrossRefGoogle Scholar
  22. 22.
    Solti F, Vecsey T, Kekesi V, Juhasz-Nagy A (1989) The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovasc Res 23(10):882–886PubMedCrossRefGoogle Scholar
  23. 23.
    Bode F, Katchman A, Woosley RL, Franz MR (2000) Gadolinium decreases stretch-induced vulnerability to atrial fibrillation. Circulation 101(18):2200–2205PubMedCrossRefGoogle Scholar
  24. 24.
    Shinagawa K, Shi YF, Tardif JC, Leung TK, Nattel S (2002) Dynamic nature of atrial fibrillation substrate during development and reversal of heart failure in dogs. Circulation 105(22):2672–2678PubMedCrossRefGoogle Scholar
  25. 25.
    Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 32(3):695–703PubMedCrossRefGoogle Scholar
  26. 26.
    Pedersen OD, Bagger H, Keller N, Marchant B, Kober L, Torp-Pedersen C (2001) Efficacy of dofetilide in the treatment of atrial fibrillation-flutter in patients with reduced left ventricular function: a Danish investigations of arrhythmia and mortality on dofetilide (diamond) substudy. Circulation 104(3):292–296PubMedCrossRefGoogle Scholar
  27. 27.
    Pozzoli M, Cioffi G, Traversi E, Pinna GD, Cobelli F, Tavazzi L (1998) Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. J Am Coll Cardiol 32(1):197–204PubMedCrossRefGoogle Scholar
  28. 28.
    Joglar JA, Acusta AP, Shusterman NH, Ramaswamy K, Kowal RC, Barbera SJ, Hamdan MH, Page RL (2001) Effect of carvedilol on survival and hemodynamics in patients with atrial fibrillation and left ventricular dysfunction: retrospective analysis of the US Carvedilol Heart Failure Trials Program. Am Heart J 142(3):498–501PubMedCrossRefGoogle Scholar
  29. 29.
    Redfield MM, Kay GN, Jenkins LS, Mianulli M, Jensen DN, Ellenbogen KA (2000) Tachycardia-related cardiomyopathy: a common cause of ventricular dysfunction in patients with atrial fibrillation referred for atrioventricular ablation. Mayo Clin Proc 75(8):790–795PubMedCrossRefGoogle Scholar
  30. 30.
    Davy JM, Herold M, Hoglund C, Timmermans A, Alings A, Radzik D, Van Kempen L (2008) Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the Efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study. Am Heart J 156(3):e521–e529CrossRefGoogle Scholar
  31. 31.
    Kober L, Torp-Pedersen C, McMurray JJ, Gotzsche O, Levy S, Crijns H, Amlie J, Carlsen J (2008) Increased mortality after dronedarone therapy for severe heart failure. N Engl J Med 358(25):2678–2687PubMedCrossRefGoogle Scholar
  32. 32.
    Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JM, Buxton AE, Camm AJ, Connolly SJ, Dubuc M, Ducharme A, Guerra PG, Hohnloser SH, Lambert J, Le Heuzey JY, O’Hara G, Pedersen OD, Rouleau JL, Singh BN, Stevenson LW, Stevenson WG, Thibault B, Waldo AL (2008) Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med 358(25):2667–2677PubMedCrossRefGoogle Scholar
  33. 33.
    Van Gelder IC, Groenveld HF, Crijns HJ, Tuininga YS, Tijssen JG, Alings AM, Hillege HL, Bergsma-Kadijk JA, Cornel JH, Kamp O, Tukkie R, Bosker HA, Van Veldhuisen DJ, Van den Berg MP (2010) Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 362(15):1363–1373PubMedCrossRefGoogle Scholar
  34. 34.
    Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, Marinchak RA, Flaker G, Schron E, Orav EJ, Hellkamp AS, Greer S, McAnulty J, Ellenbogen K, Ehlert F, Freedman RA, Estes NA III, Greenspon A, Goldman L (2002) Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med 346(24):1854–1862PubMedCrossRefGoogle Scholar
  35. 35.
    Khan MN, Jais P, Cummings J, Di Biase L, Sanders P, Martin DO, Kautzner J, Hao S, Themistoclakis S, Fanelli R, Potenza D, Massaro R, Wazni O, Schweikert R, Saliba W, Wang P, Al-Ahmad A, Beheiry S, Santarelli P, Starling RC, Dello Russo A, Pelargonio G, Brachmann J, Schibgilla V, Bonso A, Casella M, Raviele A, Haissaguerre M, Natale A (2008) Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med 359(17):1778–1785PubMedCrossRefGoogle Scholar
  36. 36.
    Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A (2002) Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) trial. JAMA 288(24):3115–3123PubMedCrossRefGoogle Scholar
  37. 37.
    Brignole M, Gammage M, Puggioni E, Alboni P, Raviele A, Sutton R, Vardas P, Bongiorni MG, Bergfeldt L, Menozzi C, Musso G (2005) Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 26(7):712–722PubMedCrossRefGoogle Scholar
  38. 38.
    Leon AR, Greenberg JM, Kanuru N, Baker CM, Mera FV, Smith AL, Langberg JJ, DeLurgio DB (2002) Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 39(8):1258–1263PubMedCrossRefGoogle Scholar
  39. 39.
    Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, Pires LA (2005) Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 16(11):1160–1165PubMedCrossRefGoogle Scholar
  40. 40.
    Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, Djiane P, Mabo P, Levy T, Gadler F, Bailleul C, Daubert JC (2002) Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 23(22):1780–1787PubMedCrossRefGoogle Scholar
  41. 41.
    Linde C, Braunschweig F, Gadler F, Bailleul C, Daubert JC (2003) Long-term improvements in quality of life by biventricular pacing in patients with chronic heart failure: results from the Multisite Stimulation in Cardiomyopathy study (MUSTIC). Am J Cardiol 91(9):1090–1095PubMedCrossRefGoogle Scholar
  42. 42.
    Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC (2002) Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 40(1):111–118PubMedCrossRefGoogle Scholar
  43. 43.
    Bradley DJ, Shen WK (2007) Atrioventricular junction ablation combined with either right ventricular pacing or cardiac resynchronization therapy for atrial fibrillation: the need for large-scale randomized trials. Heart Rhythm 4(2):224–232PubMedCrossRefGoogle Scholar
  44. 44.
    Dong K, Shen WK, Powell BD, Dong YX, Rea RF, Friedman PA, Hodge DO, Wiste HJ, Webster T, Hayes DL, Cha YM (2010) Atrioventricular nodal ablation predicts survival benefit in patients with atrial fibrillation receiving cardiac resynchronization therapy. Heart Rhythm 7(9):1240–1245PubMedCrossRefGoogle Scholar
  45. 45.
    Cha YM, Redfield MM, Shen WK, Gersh BJ (2004) Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle. Circulation 109(23):2839–2843PubMedCrossRefGoogle Scholar
  46. 46.
    Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NA III, Page RL, Ezekowitz MD, Slotwiner DJ, Jackman WM, Stevenson WG, Tracy CM, Fuster V, Ryden LE, Cannom DS, Le Heuzey JY, Crijns HJ, Olsson SB, Prystowsky EN, Halperin JL, Tamargo JL, Kay GN, Jacobs AK, Anderson JL, Albert N, Hochman JS, Buller CE, Kushner FG, Creager MA, Ohman EM, Ettinger SM, Guyton RA, Tarkington LG, Yancy CW (2011) 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (updating the 2006 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 123(1):104–123PubMedCrossRefGoogle Scholar
  47. 47.
    Vorperian VR, Havighurst TC, Miller S, January CT (1997) Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol 30(3):791–798PubMedCrossRefGoogle Scholar
  48. 48.
    Hsu LF, Jais P, Sanders P, Garrigue S, Hocini M, Sacher F, Takahashi Y, Rotter M, Pasquie JL, Scavee C, Bordachar P, Clementy J, Haissaguerre M (2004) Catheter ablation for atrial fibrillation in congestive heart failure. N Engl J Med 351(23):2373–2383PubMedCrossRefGoogle Scholar
  49. 49.
    Chen MS, Marrouche NF, Khaykin Y, Gillinov AM, Wazni O, Martin DO, Rossillo A, Verma A, Cummings J, Erciyes D, Saad E, Bhargava M, Bash D, Schweikert R, Burkhardt D, Williams-Andrews M, Perez-Lugones A, Abdul-Karim A, Saliba W, Natale A (2004) Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function. J Am Coll Cardiol 43(6):1004–1009PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, New York 2013

Authors and Affiliations

  • Mackram F. Eleid
    • 1
  • Yong-Mei Cha
    • 1
  • Win-Kuang Shen
    • 2
  1. 1.Division of Cardiovascular Diseases, Department of Internal MedicineMayo Clinic College of MedicineRochesterUSA
  2. 2.Division of Cardiovascular Diseases, Department of Internal MedicineMayo Clinic College of MedicinePhoenixUSA

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