Atrial fibrillation and acute decompensated heart failure.

نویسنده

  • John P DiMarco
چکیده

Atrial fibrillation (AF) is a common rhythm in patients with acute decompensated heart failure (ADHF). Registry and trial data1,2 indicate that 20% to 35% of patients with ADHF who are admitted to the hospital will be in AF at presentation. In about one third of these patients, the AF will be of recent onset. Despite the high frequency with which the combination of AF and ADHF is encountered, there are few published data that specifically address this problem. AF and worsening heart failure interact in a dangerous pattern. The adverse effects of AF in patients with heart failure may include loss of atrial transport, rapid and irregular ventricular rates, and toxic effects of antiarrhythmic drug therapy. Worsened heart failure, in turn, leads to increased atrial stretch and heightened sympathetic tone. These latter changes make the AF more resistant to treatment using either a rate-control or a rhythm-control strategy (Figure 1). The immediate general goals of therapy in ADHF are to improve symptoms, restore oxygenation, improve organ perfusion, and limit cardiac and renal injury.3 In patients with sinus rhythm and ADHF, the appropriate use of vasodilators, oxygen, diuretics, positive inotropic agents, and mechanical devices to support ventilation or cardiac output forms the cornerstone of therapy. In patients who present with AF, however, additional treatment decisions are required.

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عنوان ژورنال:
  • Circulation. Heart failure

دوره 2 1  شماره 

صفحات  -

تاریخ انتشار 2009