Patients with heart failure due to the presence of cardiac remodeling and neuromuscular activation, can lead to an increased incidence of arrhythmia or arrhythmia exacerbations. In August 2015, the European Heart Rhythm Association (EHR) / European Heart Failure Association (HFA) jointly issued a consensus document on heart failure with arrhythmias and was supported by the American Heart Rhythm Society (HRS) and the Asia Pacific Rhythm Society (APHRS).
1. General interventions
(1) Despite the high prevalence of arrhythmias in heart failure patients, ventricular arrhythmias (VA) screening in patients with asymptomatic heart failure is not recommended. But should be routinely ECG or at least regularly measure the pulse, and in high-risk groups in the management of asymptomatic patients with atrial fibrillation.
(2) continuous VA with or without symptoms should be given treatment.
2. Atrial fibrillation
(1) Most patients with heart failure (EF reduction or retention) and atrial fibrillation should be treated with oral anticoagulants (VKA or NOAC) according to the CHAsDSs-VASC score, taking into account their risk of bleeding (HAS-BLED score). The SAMe-TT2R2 score can be used to aid in the decision-making of VKA or NOAC therapy.
(2) heart failure patients with atrial fibrillation, heart rate control is not better than rhythm control, but patients with symptomatic atrial fibrillation should try to rhythm control.
(3) amiodarone is the rhythm control of the drug of choice, the proposed use of β-blockers, digoxin or combination of ventricular rate control. Regular screening of side effects is required.
(4) heart rate control seems to be the first choice for patients with acute heart failure treatment strategy. After the acute phase of heart failure, rhythm control should be re-assessed indications.
(5) should not only improve the prognosis of patients with heart failure with atrial fibrillation for the purpose of the use of β-blockers. Catheter ablation may be considered in patients with symptomatic atrial fibrillation who have failed medical therapy or who have a good atrial structure. Treatment of patients with symptomatic or uncontrolled refractory atrial fibrillation should consider implantation of a biventricular pacemaker followed by atrioventricular node ablation (pacing and cautery). Atrial natriuretic ablation is also necessary in patients with persistent atrial fibrillation and biventricular pacing failure (fused pulsatile) cardiac resynchronization therapy (CRT) in patients with heart failure.