AFib, described by Eugene Braunwald as a 21st-century epidemic, significantly impacts mortality, stroke, and HF risks. AFib often originates in the pulmonary veins, causing the atrium to fibrillate, leading to loss of atrial contraction and increased risk of thrombosis. Management of AFib includes the ABC approach: Anticoagulation, Better symptom control, and Control of comorbidities.
A critical aspect of AFib management is catheter ablation, which isolates the pulmonary veins to maintain sinus rhythm. Catheter ablation is particularly beneficial for HF patients, who frequently develop AFib (30%-40%), leading to tachycardia-related cardiomyopathy due to rapid and irregular heart rates and worsening their prognosis.
AFib exacerbates HF through the 'dark triad': Loss of atrial contraction and atrioventricular synchrony, rapid heart rates, and irregular RR intervals. These factors reduce systolic function, increase left ventricular (LV) filling pressures, reduce cardiac output, and heighten systemic vascular resistance. Irregular RR intervals cause calcium overload, worsening LV dysfunction.
Catheter ablation has shown promise in improving outcomes for HF patients living with AFib. Studies have demonstrated that catheter ablation significantly reduces mortality and hospitalisation compared to medical therapy. Subgroup analyses revealed that patients <65-years, with paroxysmal AFib, or with ejection fractions >25%, benefit most from ablation. This underscores the potential of catheter ablation as a superior strategy for managing AFib in patients living with HF, particularly those in early stages of the disease. To watch a replay of the webinar, click here or scan the QR code.
