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Management of Atrial Fibrillation in the Patient With Heart Failure: An Expert Interview With S. Adam Strickberger, MD

S. Adam Strickberger, MD, Professor of Medicine, Georgetown University School of Medicine, Washington, DC; Director, Arrhythmia Center, Washington Hospital Center, Washington, DC

Editor's Note:

Patients with both heart failure (HF) and atrial fibrillation (AF) offer a unique set of challenges and limitations for the physicians who treat them. In fact, when these 2 disorders present concurrently, they interact to affect hemodynamic functioning in a variety of ways, with the end result being worsening heart function and a poorer prognosis for the patient. Numerous studies have shown that AF contributes to the progression of HF, and the longer a patient has HF, the greater chance there is of developing AF. These findings point to the importance of appropriately treating both AF and HF simultaneously, but this is often a difficult task. Many AF treatment options are either risky or ineffective in these patients, and physicians often must walk a fine line when choosing which treatment approach to pursue.

To gain a clinical perspective on these issues, Medscape recently spoke with S. Adam Strickberger, MD, Director of the Arrhythmia Center at Washington Hospital Center (Washington, DC). In the following interview, Dr. Strickberger provides an overview of current AF therapeutic options and their advantages and disadvantages in various HF populations. He also shares his thoughts on the use of curative catheter ablation and atrioventricular (AV) node ablation in this patient population. According to Dr. Strickberger, there are numerous factors that need to be taken into consideration when treating AF in patients with HF, but the biggest challenge to physicians still centers on the choice between rate control and rhythm control.
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