Drugs and Ablation in Patients with Atrial Fibrillation and Heart Failure
Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general population. Its prevalence ranges from 0.5% to 9% between the ages of 50 and 80 years. It may occur in the clinical history of any patient with cardiopathy and even in apparently healthy people or those with minor structural anomalies of the heart . Its presence causes a rise in morbidity and mortality due to the loss of atrial function and the consequent decrease in heart performance and increase in embolic risk. Very often AF is associated with disabling symptoms such as palpitations, which alone can significantly influence quality of life. Moreover, literature data  suggest that the incidence of this arrhythmia increases dramatically in patients with heart failure. In those with asymptomatic or symptomatic left ventricular systolic dysfunction it is independently associated with an increased risk of all-cause mortality. Persistently elevated ventricular rate during AF can produce dilated ventricular cardiomyopathy. Heart failure may thus be a consequence of rather than the cause of AF in clinical practice. For this reason, recovery and maintenance of sinus rhythm is one of the main objectives of treatment. However, antiarrhythmic drug therapy of AF is often unsatisfactory because recurrences frequently occur. Only 60% of patients remain in sinus rhythm after 6 months . Moreover, antiarrhythmic therapy with class I drugs in patients with heart failure leads to an increase in mortality, so that the only efficient and safe drug therapy is amiodarone.
KeywordsAtrial Fibrillation Pulmonary Vein Antiarrhythmic Drug Atrial Flutter Ablative Therapy
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