27
Table 23. Heart Failure (cont'd)
Recommendations COR LOE
Assessment of heart rate control during exercise and
adjustment of pharmacological treatment to keep the rate
in the physiological range is useful in symptomatic patients
during activity.
I C
Digoxin is effective to control resting heart rate in patients
with HF with reduced EF.
I C
A combination of digoxin and a beta blocker (or a
nondihydropyridine calcium channel antagonist for patients
with HFpEF) is reasonable to control resting and exercise
heart rate in patients with AF.
IIa B
It is reasonable to perform AV node ablation with ventricular
pacing to control heart rate when pharmacological therapy is
insufficient or not tolerated.
IIa B
Intravenous amiodarone can be useful to control the heart
rate in patients with AF when other measures are unsuccessful
or contraindicated.
IIa C
For patients with AF and RVR causing or suspected of causing
tachycardia-induced cardiomyopathy, it is reasonable to
achieve rate control by either AV nodal blockade or a rhythm-
control strateg y.
IIa B
For patients with chronic HF who remain symptomatic from
AF despite a rate-control strateg y, it is reasonable to use a
rhythm-control strateg y.
IIa C
Oral amiodarone may be considered when resting and exercise
heart rate cannot be adequately controlled using a beta
blocker (or a nondihydropyridine calcium channel antagonist
in patients with HFpEF) or digoxin, alone or in combination.
IIb C
AV node ablation may be considered when the rate cannot
be controlled and tachycardia-mediated cardiomyopathy is
suspected.
IIb C
AV node ablation should NOT be performed without a
pharmacological trial to achieve ventricular rate control.
III: Harm C
For rate control, intravenous nondihydropyridine calcium
channel antagonists, intravenous beta blockers, and
dronedarone should NOT be administered to patients with
decompensated HF.
III: Harm C
Table 24. Familial (Genetic) AF
Recommendation COR LOE
For patients with AF and multigenerational family members
with AF, referral to a tertiary care center for genetic
counseling and testing may be considered.
IIb C
