RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .
Use and Effectiveness of Warfarin in Medicare Beneficiaries With Atrial Fibrillation
Background and Purpose — More than 2 million Americans have atrial fibrillation , and without antithrombotic therapy , their stroke rate is increased 5-fold . In r and omized controlled trials , warfarin prevented 65 % of ischemic strokes ( hazard ratio [ HR ] , 0.35 ; 95 % CI , 0.26 to 0.48 ) compared with no antithrombotic therapy . However , the effectiveness of warfarin therapy outside of clinical trials is unknown , especially in black and Hispanic population s. Our goal was to quantify use of warfarin therapy , frequency of International Normalized Ratio monitoring , and effectiveness for stroke prophylaxis in Medicare beneficiaries with atrial fibrillation . Methods — This was a cohort study of Medicare beneficiaries with atrial fibrillation who were hospitalized between March 1998 and April 1999 in all 50 US states . The primary outcome was incident hospitalizations for ischemic stroke based on vali date d International Classification of Diseases , 9th Revision , Clinical Modification codes . Results — Two thirds of ideal anticoagulation c and i date s were prescribed warfarin on hospital discharge . In unadjusted analyses , the stroke rates per 100 patient years of warfarin therapy were 5.2 in ( non-Hispanic ) white Medicare beneficiaries , 10.6 in black beneficiaries , and 12.2 in Hispanic beneficiaries . After adjusting for comorbid conditions , warfarin prescription was more frequent and monitoring more regular in white Medicare beneficiaries than in black or Hispanic beneficiaries ( P<0.0001 ) . Warfarin use was associated with 35 % fewer ischemic strokes ( HR , 0.65 ; 95 % CI , 0.55 to 0.76 ) compared with no antithrombotic therapy but was less effective in black and Hispanic beneficiaries ( P for interaction=0.048 ) . Conclusions — The use , monitoring , and effectiveness of warfarin therapy are suboptimal in Medicare beneficiaries , especially in black and Hispanic beneficiaries
RECENT FINDINGS Several r and omized control trials and systematic review s demonstrate the safety and efficacy of atrial fibrillation ablation in patients with heart failure and left ventricular systolic dysfunction .
In multiple trials , these patients have shown clinical benefit from atrial fibrillation ablation including improved left ventricular systolic function , quality of life , and clinical heart failure symptoms .
SUMMARY Atrial fibrillation ablation in heart failure patients remains well tolerated with an overall efficacy comparable to atrial fibrillation ablation in patients without heart failure .
There is consistent evidence for the clinical benefit of atrial fibrillation ablation in heart failure patients with left ventricular systolic dysfunction and limited evidence for atrial fibrillation ablation in heart failure patients with preserved ejection fraction .
Currently , there is insufficient data regarding the safety and efficacy of left atrial appendage closure devices in heart failure patients
PURPOSE OF REVIEW Patients with atrial fibrillation and heart failure experience an increased morbidity and mortality from the hemodynamic consequences of atrial fibrillation and an increased stroke risk .
Consequently , there has been increased attention to procedural alternatives to pharmacologic rhythm control and anticoagulation for stroke prevention .
This review aims to evaluate the evidence for atrial fibrillation ablation and left atrial appendage closure in heart failure patients .