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Management
9.2. Management of AF in Patients With HF*
COR LOE
Recommendations
1 B-NR 1. In patients who present with a new diagnosis of HFrEF
and AF, arrhythmia-induced cardiomyopathy should be
suspected, and an early and aggressive approach to AF
rhythm control is recommended.
1 A 2. In appropriate patients with AF and HFrEF who are on
GDMT, and with reasonable expectation of procedural
benefit (Figure 24), catheter ablation is beneficial to improve
symptoms, QOL, ventricular function, and cardiovascular
outcomes.
2a B-NR 3. In appropriate patients with symptomatic AF and heart
failure with preserved ejection fraction (HFpEF) with
reasonable expectation of benefit, catheter ablation can be
useful to improve symptoms and improve QOL.
2a B-R 4. In patients with AF and HF, digoxin is reasonable for rate
control, in combination with other rate-controlling agents or
as monotherapy if other agents are not tolerated.
2a B-NR 5. In patients with AF and HF with rapid ventricular rates
in whom beta blockers or calcium channel blockers are
contraindicated or ineffective, intravenous amiodarone is
reasonable for acute rate control.
†
2a B-R 6. In patients with AF, HFrEF (LVEF <50%), and refractory
rapid ventricular response who are not candidates for or in
whom rhythm control has failed, AVNA and biventricular
pacing therapy can be useful to improve symptoms, QOL,
and EF.
2a B-NR 7. In patients with AF, HF, and implanted biventricular pacing
therapy in whom an effective pacing percentage cannot
be achieved with pharmacological therapy, AVNA can be
beneficial to improve functional class, reduce the risk of ICD
shock, and improve survival.
2a B-NR 8. In patients with AF-induced cardiomyopathy who have
recovered LV function, long-term surveillance can be
beneficial to detect recurrent AF in view of the high risk of
recurrence of arrhythmia-induced cardiomyopathy.
9. Management of Patients With HF
9.1. General Considerations for AF and HF
