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 .
Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy.
To assess the potential improvement in left ventricular ejection fraction after cardioversion of  chronic atrial fibrillation  to sinus rhythm in idiopathic dilated cardiomyopathy , we studied prospect ively 17 patients , aged 58 + /- 6 years , by radionuclide angiocardiography at rest .  Left ventricular ejection fraction was determined before treatment and at a mean delay of 4.7 months after cardioversion . Return to sinus rhythm was obtained in 12 patients , pharmacologically or by electrical cardioversion . Five patients remained in atrial fibrillation . No clinical , echocardiographic or haemodynamic finding could predict the success of cardioversion . In chronic atrial fibrillation , the ejection fraction did not change significantly : 30.0 + /- 9.1 % ( 19 to 44 % ) at the first evaluation and 29.5 + /- 8.3 % ( 22 to 41 % ) after 4.7 months . After successful cardioversion , left ventricular ejection fraction improved from 32.1 + /- 5.3 % ( 24 to 41 % ) to 52.9 + /- 9.7 % ( 37 to 71 % ) ( P less than 0.001 ) . The difference was 20.8 + /- 11.3 % and left ventricular ejection fraction was normalized in 50 % ( 6/12 ) of the patients . There was a significant reduction in the cardiothoracic ratio on chest X-rays and of the left ventricular end-diastolic diameter on echocardiography ; fractional shortening increased ( 27.7 + /- 4.3 % vs 20.3 + /- 2.7 % , P less than 0.01 ) . A third evaluation was realized after a mean delay of 11.7 months in the patients with successful cardioversion . Sinus rhythm was present in 83 % ( 10/12 ) of the patients : seven patients were reevaluated by radionuclide angiography . The improvement in left ventricular function observed at the 4.7 months evaluation was still present . In two patients with recurrence of atrial fibrillation , there was a severe deterioration of left ventricular systolic function . ( ABSTRACT TRUNCATED AT 250 WORDS
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 .