Circulation. 1998;98:941-942
(Circulation. 1998;98:941-942.)
© 1998 American Heart Association, Inc.
Atrial Fibrillation and Congestive Heart Failure
The Intersection of Two Common Diseases
Melvin M. Scheinman, MD
From the Department of Medicine and the Cardiovascular Research
Institute, University of California, San Francisco.
Correspondence to Melvin M. Scheinman, MD, 500 Parnassus Ave, San Francisco, CA 94143-1354. E-mail scheinman@ep4.ucsf.edu
Key Words: Editorials • fibrillation • heart failure
Atrial
fibrillation is the most common sustained cardiac arrhythmia,
and congestive heart failure is an increasingly frequent diagnosis as
our population tends to age. Appropriate management of these patients
has engaged clinicians for many years. It was long appreciated that
atrial fibrillation, per se, without associated cardiac disease could
result in congestive heart failure and that prompt treatment resulting
in either restoration of sinus rhythm or rate control could obviate the
signs and symptoms of congestive heart
failure.1 2 3
More recently, a spate of observations have shown that application
of catheter ablative techniques to patients with atrial fibrillation
with rapid ventricular rates unresponsive to drug therapy
could likewise result in improved cardiac
function.4 5 6 7 8 In the latter studies, patients
generally had proved to be refractory to medical therapy before being
offered catheter ablation of the atrioventricular (AV)
junction.
Elsewhere in this issue of Circulation, Brignole et
al9 report a novel controlled trial
comparing drug versus AV junctional ablation for patients with atrial
fibrillation and congestive heart failure. In this study, a total of 66
patients with chronic atrial fibrillation were randomized to receive
either drug therapy for rate control or ablation and insertion of a
VVIR pacemaker. These patients were followed up for at least 12 months
with serial questionnaires used to assess changes in either specific
symptoms (ie, palpitations, dyspnea), global quality-of-life issues
(Minnesota LHFQ), or NYHA functional class. In addition, cardiac
performance was assessed by serial exercise and
echocardiographic studies.
It was found, not unexpectedly, that patients in both . . . [Full Text of this Article]
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