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Published in:

01-09-2019 | Cardiomyopathy

Invasive therapies for patients with concomitant heart failure and atrial fibrillation

Authors: Wei Wei, Michael Shehata, Xunzhang Wang, Fang Rao, Xianzhan Zhan, Huiming Guo, Xianhong Fang, Hongtao Liao, Jian Liu, Hai Deng, Yang Liu, Yumei Xue, Shulin Wu

Published in: Heart Failure Reviews | Issue 5/2019

Abstract

Atrial fibrillation (AF) and heart failure (HF) are two clinical entities that can present either separately or concurrently. One entity can lead to the other and vice versa as AF can not only be the underlying etiology of HF but also exacerbate HF due to other cardiac diseases. Besides prevention of cerebral and systemic embolism and elimination of AF-related symptoms, restoration of sinus rhythm for AF patients helps to avoid or reduce HF, irrespective of their underlying heart disease. Successful rates of medical therapy for AF are low in persistent AF, and much lower in long-standing AF, while invasive procedures for AF yield promising results. In this review, the authors evaluate the value of invasive therapies for HF patients complicated with non-valvular AF. We examine this clinical problem by interpreting the relationships between these two entities: the mechanism of tachycardia-induced cardiomyopathy (TIC), past opinions about rhythm control and rate control of AF, discrimination of HF-related AF and AF-induced HF, how to identify the AF patients that could benefit from invasive therapies, and how to select invasive therapies for different AF patients and peri-operative treatments.

Lishmanov A, Chockalingam P, Senthilkumar A, Chockalingam A (2010) Tachycardia-induced cardiomyopathy: evaluation and therapeutic options. Congest Heart Fail 16:122–126PubMedCrossRef

Sairaku A, Nakano Y, Oda N et al (2014) Incomplete cure of tachycardia-induced cardiomyopathy secondary to rapid atrial fibrillation by heart rate control without sinus conversion. J Cardiovasc Electrophysiol 25(10):1037–1043PubMedCrossRef

Nassir FM, Johannes B, Dietrich A et al (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378(5):417–427CrossRef

Verheule S, Wilson E, Everett TT et al (2003) Alterations in atrial electrophysiology and tissue structure in a canine model of chronic atrial dilatation due to mitral regurgitation. Circulation. 107:2615–2622PubMedPubMedCentralCrossRef

Li D, Melnyk P, Feng J, Wang Z, Petrecca K, Shrier A, Nattel S (2000) Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation. 101:2631–2638PubMedCrossRef

Sanders P, Morton JB, Davidson NC, Spence SJ, Vohra JK, Sparks PB, Kalman JM (2003) Electrical remodeling of the atria in congestive heart failure: electrophysiological and electrophysiological and electroanatomic mapping in humans. Circulation. 108:1461–1468PubMedCrossRef

Wei W, Rao F, Liu FZ, Xue Y, Deng C, Wang Z, Zhu J, Yang H, Li X, Zhang M, Fu Y, Zhu W, Shan Z, Wu S (2018) Involvement of Smad3 pathway in atrial fibrosis induced by elevated hydrostatic pressure. J Cell Physiol 233(6):4981–4989PubMedCrossRef

Everett TH, Olgin JE (2007) Atrial fibrosis and the mechanisms of atrial fibrillation. Heart Rhythm 4:S24–S27PubMedCrossRef

Boos CJ, Anderson RA, Lip GY (2006) Is atrial fibrillation an inflammatory disorder? Eur Heart J 27:136–149PubMedCrossRef

10.

Boo CJ, Lip GY (2008) Inflammation and atrial fibrillation: cause or effect? Heart. 94:133–134CrossRef

11.

Reil JC, Hohl M, Selejan S, Lipp P, Drautz F, Kazakow A, Münz BM, Müller P, Steendijk P, Reil GH, Allessie MA, Böhm M, Neuberger HR (2012) Aldosterone promotes atrial fibrillation. Eur Heart J 33:2098–2108PubMedCrossRef

12.

Khasnis A, Jongnarangsin K, Abela G et al (2005) Tachycardia-induced cardiomyopathy: a review of literature. Pacing Clin Electrophysiol 28:710–721PubMedCrossRef

13.

Deedwania PC, Lardizabal JA (2010) Atrial fibrillation in heart failure: a comprehensive review. Am J Med 123:198–204PubMedCrossRef

14.

Calvo N, Bisbal F, Guiu E, Ramos P, Nadal M, Tolosana JM, Arbelo E, Berruezo A, Sitges M, Brugada J, Mont L (2013) Impact of atrial fibrillation-induced tachycardiomyopathy in patients undergoing pulmonary vein isolation. Int J Cardiol 168:4093–4097PubMedCrossRef

15.

Ellis ER, Josephson ME (2013) What about tachycardia-induced cardiomyopathy? Arrhythmia Electrophysiol Rev 2(2):82–90CrossRef

16.

Brill IC (1937) Auricular fibrillation with congestive failure and no other evidence of organic heart disease. Am Heart J 13:175–182CrossRef

17.

Parkinson J, Campbell M (1930) Paroxysmal auricular fibrillation: a record of two hundred patients. Q J Med 24:67–100CrossRef

18.

Phillips E, Levine S (1949) Auricular fibrillation without other evidence of heart disease: a cause of reversible heart failure. Am J Med 7:478–489PubMedCrossRef

19.

Ellis ER, Josephson ME (2013) What about tachycardia-induced cardiomyopathy? Arrhythmia Electrophysiol Rev 2(2):82–90CrossRef

20.

Riegger AJ, Liebau G (1982) The renin-angiotensin-aldosterone system, antidiuretic hormone and sympathetic nerve activity in an experimental model of congestive heart failure in the dog. Clin Sci (Lond) 62:465–469CrossRef

21.

Moe GW, Stopps TP, Angus C, Forster C, de Bold AJ, Armstrong PW (1989) Alterations in serum sodium in relation to atrial natriuretic factor and other neuroendocrine variables in experimental pacing-induced heart failure. J Am Coll Cardiol 13:173–179PubMedCrossRef

22.

Moe GW, Canepa-Anson R, Armstrong PW (1992) Atrial natriuretic factor: pharmacokinetics and cyclic GMP response in relation to biologic effects in severe heart failure. J Cardiovasc Pharmacol 19:691–700PubMed

23.

Moe GW, Grima EA, Wong NL et al (1993) Dual natriuretic peptide system in experimental heart failure. J Am Coll Cardiol 22:891–898PubMedCrossRef

24.

Van Gelder IC, Crijns HJ, Blanksma PK et al (1993) Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease. Am J Cardiol 72:560–566PubMedCrossRef

25.

Maggioni AP, Dahlstrom U, Filippatos G et al (2013) EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15:808–817PubMedCrossRef

26.

Corley SD, Epstein AE, DiMarco JP et al (2004) Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 109:1509–1513PubMedCrossRef

27.

Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, Bourassa MG, Arnold JMO, 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 358:2667–2677PubMedCrossRef

28.

Van Gelder IC, Hagens VE, Bosker HA et al (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840PubMedCrossRef

29.

Kheiri B, Osman M, Abdalla A et al (2018) Catheter ablation of atrial fibrillation with heart failure: an updated meta-analysis of randomized trials. Int J Cardiol S0167–5273(18):32169–32167

30.

Pedersen OD, Bagger H, Keller N, Marchant B, Køber 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):292–296PubMedCrossRef

31.

Hagens VE, Crijns HJ, Van Veldhuisen DJ et al (2005) Rate control versus rhythm control for patients with persistent atrial fibrillation with mild to moderate heart failure: results from the RAte Control versus Electrical cardioversion (RACE) study. Am Heart J 149(6):1106–1111PubMedCrossRef

32.

Shelton RJ, Clark AL, Goode K, Rigby AS, Houghton T, Kaye GC, Cleland JGF (2009) A randomised, controlled study of rate versus rhythm control in patients with chronic atrial fibrillation and heart failure: (CAFÉ-II Study). Heart. 95:924–930PubMedCrossRef

33.

Wang M, Cai S, Ding W, Deng Y, Zhao Q (2017) Efficacy and effects on cardiac function of radiofrequency catheter ablation vs. direct current cardioversion of persistent atrial fibrillation with left ventricular systolic dysfunction. PLoS One 12(3):e0174510PubMedPubMedCentralCrossRef

34.

Prabhu S, Ling LH, Ullah W et al (2016) The impact of known heart disease on long-term outcome s of catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction: a multicenter international study. J Cardiovasc Electrophysiol 27(3):281–289PubMedCrossRef

35.

Hunter RJ, Berriman TJ, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Page SP, Ullah W, Unsworth B, Mayet J, Dhinoja M, Earley MJ, Sporton S, Schilling RJ (2014) A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol 7:31–38PubMedCrossRef

36.

Jones DG, Haldar SK, Hussain W, Sharma R, Francis DP, Rahman-Haley SL, McDonagh TA, Underwood SR, Markides V, Wong T (2013) A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. J Am Coll Cardiol 61:1894–1903PubMedCrossRef

37.

MacDonald MR, Connelly DT, Hawkins NM et al (2011) Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial. Heart. 97:740–747PubMedCrossRef

38.

Cappato R, Calkins H, Chen SA et al (2010) Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 3:323–328

39.

Khasnis A, Jongnarangsin K, Abela G et al (2005) Tachycardia-induced cardiomyopathy: a review of literature. Pacing Clin Electrophysiol 28:710–721PubMedCrossRef

40.

Umana E, Solares CA, AlpertMA: Tachycardia-induced cardiomyopathy. Am J Med 2003;114:51–55

41.

Lishmanov A, Chockalingam P, Senthilkumar A, Chockalingam A (2010) Tachycardia-induced cardiomyopathy: evaluation and therapeutic options. Congest Heart Fail 16:122–126PubMedCrossRef

42.

Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC (2012) Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. Circ Heart Fail 5(2):191–201PubMedCrossRef

43.

Wasywich CA, Pope AJ, Somartne J et al (2010) Atrial fibrillation and the risk of death in patients with heart failure: a literature-based meta-analysis. Intern Med J 40:347–356PubMedCrossRef

44.

Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 107:2920–2925PubMedCrossRef

45.

Maisel WH, Stevenson LW (2003) Atrial fibrillation in heart failure: epidemiology, pathophysiology, and rationale for therapy. Am J Cardiol 91:2D–8DPubMedCrossRef

46.

Smit MD, Moes ML, Maass AH, Achekar ID, van Geel PP, Hillege HL, van Veldhuisen DJ, van Gelder IC (2012) The importance of whether atrial fibrillation or heart failure develops first. Eur J Heart Fail 14(9):1030–1040PubMedCrossRef

47.

Folkeringa J, Crijns HJGM, Van Veldhuisen DJ (2004) Prognosis of atrial fibrillation in congestive heart failure. Circulation. 109:e11PubMed

48.

Yamada T, Fukunami M, Shimonagata T, Kumagai K, Ogita H, Asano Y, Hirata A, Hori M, Hoki N (2000) Prediction of paroxysmal atrial fibrillation in patients with congestive heart failure: a prospective study FREE. J Am Coll Cardiol 35(2):405–413PubMedCrossRef

49.

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, de Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 18(11):1609–1678PubMedCrossRef

50.

Kosiuk J, Nedios S, Darma A, Rolf S, Richter S, Arya A, Piorkowski C, Gaspar T, Sommer P, Husser D, Hindricks G, Bollmann A (2014) Impact of single atrial fibrillation catheter ablation on implantable cardioverter defibrillator therapies in patients with ischaemic and nonischaemic cardiomyopathies. Europace. 16(9):1322–1326PubMedCrossRef

51.

Kato K, Ejima K, Fukushima N, Ishizawa M, Wakisaka O, Henmi R, Yoshida K, Nuki T, Arai K, Yashiro B, Manaka T, Ashihara K, Shoda M, Hagiwara N (2016) Catheter ablation of atrial fibrillation in patients with severely impaired left ventricular systolic function. Heart Vessel 31(4):584–592CrossRef

52.

Link MS, Haïssaguerre M, Natale A (2016) Ablation of atrial fibrillation: patient selection, periprocedural anticoagulation, techniques, and preventive measures after ablation. Circulation. 134(4):339–352PubMedCrossRef

53.

Prabhu S, Ling LH, Ullah W et al (2016) The impact of known heart disease on long-term outcomes of catheter ablation in patients with atrial fibrillation and left ventricular systolic dysfunction: a multicenter international study. J Cardiovasc Electrophysiol 27(3):281–289PubMedCrossRef

54.

Nedios S, Sommer P, Dagres N, Kosiuk J, Arya A, Richter S, Gaspar T, Kanagkinis N, Dinov B, Piorkowski C, Bollmann A, Hindricks G, Rolf S (2014) Long-term follow-up after atrial fibrillation ablation in patients with impaired left ventricular systolic function: the importance of rhythm and rate control. Heart Rhythm 11:344–351PubMedCrossRef

55.

Hideharu O, Takahiro O, Hideaki K et al (2015) Impact of left ventricular diastolic dysfunction on outcome of catheter ablation for atrial fibrillation in patients with hypertrophic cardiomyopathy. Circ J 79:419–424CrossRef

56.

Arora S, Lahewala S, Tripathi B et al (2018) Causes and predictors of readmission in patients with atrial fibrillation undergoing catheter ablation: a national population-based cohort study. J Am Heart Assoc 7(12):e009294PubMedPubMedCentralCrossRef

57.

Bai R, Di Biase L, Mohanty P et al (2016) Proven isolation of the pulmonary vein antrum with or without left atrial posterior wall isolation in patients with persistent atrial fibrillation. Heart Rhythm 13(1):132–140PubMedCrossRef

58.

59.

Di Biase L, Burkhardt JD, Mohanty P et al (2010) Left atrial appendage: an underrecognized trigger site of atrial fibrillation. Circulation. 122(2):109–118PubMedCrossRef

60.

Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMS(N), di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2018) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 20(1):157–208PubMedCrossRef

61.

Pokushalov E, Romanov A, Elesin D et al (2013) Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: a randomized controlled trial. J Cardiovasc Electrophysiol 24(12):1338–1343PubMedCrossRef

62.

Boersma LV, Castella M, van Boven W et al (2012) Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation. 125(1):23–30PubMedCrossRef

63.

Phan K, Phan S, Thiagalingam A, Medi C, Yan TD (2016) Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation. Eur J Cardiothorac Surg 49(4):1044–1051PubMedCrossRef

64.

Krul SP, Pison L, La Meir M et al (2014) Epicardial and endocardial electrophysiological guided thoracoscopic surgery for atrial fibrillation: a multidisciplinary approach of atrial fibrillation ablation in challenging patients. Int J Cardiol 173(2):229–235PubMedCrossRef

65.

Probst J, Jidéus L, Blomström P, Zemgulis V, Wassberg E, Lönnerholm S, Malmborg H, Blomström Lundqvist C (2016) Thoracoscopic epicardial left atrial ablation in symptomatic patients with atrial fibrillation. Europace. 18(10):1538–1544PubMedCrossRef

66.

Gelsomino S, Van Breugel HN, Pison L et al (2014) Hybrid thoracoscopic and transvenous catheter ablation of atrial fibrillation. Eur J Cardiothorac Surg 45(3):401–407PubMedCrossRef

67.

Bulava A (2018) Hybrid procedures for persistent atrial fibrillation: necessity and timing of the catheter ablation stage. J Thorac Dis 10(1):E83–E86PubMedPubMedCentralCrossRef

68.

Bulava A, Mokracek A, Kurfirst V (2017) Delayed electroanatomic mapping after surgical ablation for persistent atrial fibrillation. Ann Thorac Surg 104(6):2024–2029PubMedCrossRef

69.

Budera P, Osmancik P, Herman D, Zdarska J, Talavera D, Mala A, Prochazkova R, Straka Z (2017) Midterm outcomes of two-staged hybrid ablation of persistent and long-standing persistent atrial fibrillation using the versapolar epicardial surgical device and subsequent catheter ablation. J Interv Card Electrophysiol 50(2):187–194PubMedCrossRef

70.

Brignole M, Botto GL, Mont L, Oddone D, Iacopino S, de Marchi G, Campoli M, Sebastiani V, Vincenti A, Garcia Medina D, Osca Asensi J, Mocini A, Grovale N, de Santo T, Menozzi C (2012) Predictors of clinical efficacy of ‘Ablate and Pace’ therapy in patients with permanent atrial fibrillation. Heart. 98(4):297–302PubMedCrossRef

71.

Huang W, Su L, Wu S et al (2017) Benefits of permanent His bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction. J Am Heart Assoc 1(4):6

72.

WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M et al (2016) 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Task Force on clinical practice guidelines and the Heart Failure Society of America. Circulation. 134(13):e282–e293CrossRef

73.

Strisciuglio T, Di Gioia G, Chatzikyriakou S et al (2018) Left atrial volume computed by 3D rotational angiography best predicts atrial fibrillation recurrence after circumferential pulmonary vein isolation. Int J Card Imaging 34(3):337–342CrossRef

74.

Di Lullo L, Bellasi A, Barbera V et al (2017) Pathophysiology of the cardiorenal syndromes types 1-5: an uptodate. Indian Heart J 69(2):255–265PubMedPubMedCentralCrossRef

75.

Suzuki S, Sagara K, Otsuka T, Matsuno S, Funada R, Uejima T, Oikawa Y, Koike A, Nagashima K, Kirigaya H, Yajima J, Sawada H, Aizawa T, Yamashita T (2012) Gender-specific relationship between serum uric acid level and atrial fibrillation prevalence. Circ J 76(3):607–611PubMedCrossRef

76.

He XN, Li SN, Zhan JL et al (2013) Serum uric acid levels correlate with recurrence of paroxysmal atrial fibrillation after catheter ablation. Chin Med J 126(5):860–864PubMed

77.

Liao HT, Liu FZ, Xue YM et al (2015) Predictive value of serum uric acid on left atrial spontaneous echo contrast in non-valvular atrial fibrillation patients. J Geriatr Cardiol 12(6):641–646PubMedPubMedCentral

78.

Liu FZ, Liao HT, Lin WD et al (2018) Predictive effect of hyperuricemia on left atrial stasis in non-valvular atrial fibrillation patients. Int J Cardiol (17):37479-X

Title: Invasive therapies for patients with concomitant heart failure and atrial fibrillation
Authors: Wei Wei
Michael Shehata
Xunzhang Wang
Fang Rao
Xianzhan Zhan
Huiming Guo
Xianhong Fang
Hongtao Liao
Jian Liu
Hai Deng
Yang Liu
Yumei Xue
Shulin Wu
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Cardiomyopathy
Heart Failure
Atrial Fibrillation
Published in: Heart Failure Reviews / Issue 5/2019
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-019-09795-0

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