Dr. Jean-Jacques Blanc,
This was a joint session of the ESC and the ACC. Heart failure (HF) and atrial fibrillation (AF) are epidemics. Their incidence increases rapidly with age, and the annual incidence of new AF ranges between 2 and 5%, while prevalence of AF is correlated with increase in NYHA class. Both carry a high mortality and morbidity.
AF increases morbidity and mortality in heart failure patients and remains an independent predictor of mortality (w 1.5 to 1.9-fold increase in the Framingham trial). HF begets AF by mechanical changes, neurohormonal activation and electrical alteration, while AF begets HF by mechanical changes, loss of AV synchrony, and hemodynamic alteration.
The second speaker, Prof. Harry Crijns, Netherlands, spoke about the cure of AF and concluded that there is no cure for AF in the setting of HF. However, reversal of AF leads to remodeling of atrial and in some instances, ventricular functions. When pharmacological treatments fail, there are possibilities for interventional proceduresL: AV node ablation with RV pacing and more recently, biventricular pacing, or pulmonary vein isolation. All these procedures are effective, but long term efficacy remains unknown, particularly for pulmonary vein isolation and further studies are clearly needed.
The role of drugs was evaluated by Dr. Ezekowitz (USA). Many drugs are useful, but many others are under evaluation, particularly to control rhythm (dronedarone), and several drugs are being tested to prevent stroke. Fourteen drugs are currently being tested in total. However, these drugs will not be available before 12 months after the end of the control trials, which means probably at least 2 or 3 years from now.
Heart failure and atrial fibrilation
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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