Fibrilace síní při srdečním selhání

Cor Vasa 2003, 44(9):451-456

Atrial fibrillation in heart failure

Jan Kohoutek: Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

Data from experimental studies suggest some pathophysiological differences between atrial fibrillation (AF) in heart failure and idiopathic AF. While an effect of AF on the prognosis of patients with chronic heart failure (CHF) has not been documented, a disadvantage of AF is its impact on the severity of heart failure (HF) symptoms and also, without any doubt whatsoever, on the risk of systemic embolism.
The main question is choice of the optimal therapeutic strategy involving heart rate control or ventricular rate control. Although none of the above procedures has been shown to be superior in an unselected series of AF patients, it is not known whether the same applies to HF patients. At any rate, management of AF may essentially affect the symptoms shown by these patients.
There is but a limited range of antiarrhythmic agents to be used for rhythm control. The value of non-pharmacological procedures in preventing AF recurrence in CHF patients has not been established to date.
When monitoring ventricular frequency, it is not enough to evaluate merely resting values, and exertion-induced rate should also be assessed. In cases where it is impossible to attain adequate control of ventricular response using medicinal products, unselected AV junction ablation and pacemaker implantation can be undertaken, without any concern for the patient being at risk for sudden death. The current potential of biventricular pacing or bifocal stimulation of the right ventricle may eliminate problems associated with left ventricular asynchrony which may be induced by unifocal stimulation following AV junction ablation.
Given the high risk for systemic embolism, the relevance of anticoagulation therapy is indisputable.