Rhythm versus rate control for atrial fibrillation in heart failure with preserved ejection fraction

Are arrhythmias the drivers of sudden cardiac death in heart failure with preserved ejection fraction? A review

“…75 Antiarrhythmic drugs (AAD) are effective in treatment of AF in HFpEF patients for medium-term to long-term maintenance of sinus rhythm and mortality, with class III AAD more frequently used in majority of studies followed by class IC and then class IA drugs. [75][76][77][78] Catheter ablation for AF is safe and appears to be effective in maintaining sinus rhythm in HFpEF patients similarly to what is seen in HFrEF patients, 79,80 and of equivalent efficacy to patients without heart failure. 81 There is accruing evidence from observational studies that compared with medical therapy, catheter ablation in HFpEF is associated with significant reduction is AF recurrence, [81][82][83][84] as well as heart failure hospitalization, the composite of heart failure hospitalization and mortality, and all-cause mortality alone.…”

“…The onset of AF results in loss of atrial systolic kick, increased left ventricular filling pressure, and thus setting the stage for possible decompensation of HFpEF 75 . Antiarrhythmic drugs (AAD) are effective in treatment of AF in HFpEF patients for medium‐term to long‐term maintenance of sinus rhythm and mortality, with class III AAD more frequently used in majority of studies followed by class IC and then class IA drugs 75–78 . Catheter ablation for AF is safe and appears to be effective in maintaining sinus rhythm in HFpEF patients similarly to what is seen in HFrEF patients, 79,80 and of equivalent efficacy to patients without heart failure 81 .…”

Mitral regurgitation and heart failure with preserved ejection fraction: Should we treat the muscle, the valve, or both?

“…In case of AF, rhythm control, preferably with catheter ablation, 16 has been proposed as a means of reducing functional MR by promoting atrial/annular reverse remodelling and restoring atrial and ventricular contributions to annular contraction. Finally, in case of severe MR after medical therapy, surgical mitral annuloplasty may be the most reliable surgical treatment for functional MR but reports from small studies 17 must be confirmed in a randomized controlled trial.…”

A review of the impact, pathophysiology, and management of atrial fibrillation in patients with heart failure with preserved ejection fraction

“…An observational study showed patients with rhythm control had lower rates of all-cause mortality, all-cause readmissions, HF readmissions, and ischemic stroke readmissions compared to those receiving rate control [ 135 ]. In addition, a meta-analysis of 5 observational studies showed that rhythm control (ablation and/or antiarrhythmic medications) was associated with lower all-cause mortality (odds ratio 0.735, 95 % confidence interval 0.665–0.813; P < 0.001) compared to rate control [ 136 ]. Regarding specific options for rhythm control, RCTs showed no benefit in using antiarrhythmics versus rate-controlling strategies in patients with HF.…”