Atrial fibrillation and heart failure: Rate versus rhythm control

Atrial fibrillation and heart failure are commonly coexisting conditions with important pathophysiologic interactions impacting patient management. Treatment of atrial fibrillation with impaired ventricular function is focused towards preventing adverse hemodynamic effects that may result in more symptoms and decreased exercise tolerance. While rate control using medications or atrioventricular nodal ablation combined with pacing is the primary emphasis of management, rhythm control using pharmacologic or pulmonary vein isolation remains a feasible alternative strategy for some patients. The prevalence, mechanisms, and management strategies of atrial fibrillation and heart failure are reviewed in this chapter.