Rhythm Control May Be Best for Afib in Heart Failure Patients
Individuals with heart failure and atrial fibrillation may have reduced exercise capacity with rate control, suggesting rhythm control is better.
Atrial fibrillation (afib) and heart failure both reduce the heart’s ability to pump enough blood to match the body’s needs. The decision whether to treat patients with both conditions with heart rate control or heart rhythm control can have profound effects on their quality of life and health. In a study presented at the 2016 American College of Cardiology Scientific Sessions, Cleveland Clinic cardiology fellow Mohamed Elshazly, MD, found that rate control often left the patients with reduced capacity to exercise. This was true even among patients who had preserved left ventricular function—a condition in which the left ventricle contracts normally while pumping, but doesn’t relax sufficiently to allow enough blood to enter in between beats.
Restoring normal rhythm led to improved exercise capacity, Dr. Elshazly says. “This (study) provides mechanistic evidence that a rhythmcontrol strategy may potentially improve peak exercise capacity and survival, a finding that requires future prospective appraisal in this patient population," he explains.