109
9.2. Management of AF in Patients With HF*
COR LOE
Recommendations
2b B-NR 9. In patients with suspected AF-induced cardiomyopathy or
refractory HF symptoms undergoing pharmacological rate-
control therapy for AF, a stricter rate-control strateg y (target
heart rate <80 bpm at rest and <110 bpm during moderate
exercise) may be reasonable.
2b C-LD 10. In patients with AF and HFrEF who undergo AVNA,
conduction system pacing of the His bundle or left
bundle branch area may be reasonable as an alternative to
biventricular pacing to improve symptoms, QOL, and LV
function.
3: Harm B-R 11. In patients with AF and known LVEF <40%,
nondihydropyridine calcium channel-blocking drugs should
not be administered given their potential to exacerbate HF.
3: Harm B-R 12. For patients with AF, dronedarone should not be
administered for maintenance of sinus rhythm to those with
NYHA class III and IV HF or patients who have had an
episode of decompensated HF in the past 4 weeks, due to the
risk of increased early mortality associated with worsening
HF.
* Please see other recommendations on anticoagulation in AF (Section 8.4.4, "Anticoagulation
erapy Before and Aer Catheter Ablation"), rate control in HF (Section 7, "Rate
Control"), and agents for pharmacological cardioversion (Section 7.2, "Specific
Pharmacological Agents for Rate Control") and maintenance of sinus rhythm (Section 8.3.1,
"Specific Drug erapy for Long-Term Maintenance of Sinus Rhythm").
†
Consider the risk of cardioversion and stroke when using amiodarone as a rate-control agent.
(cont'd)
