Atrial fibrillation and heart failure with reduced ejection fraction are increasing in prevalence worldwide. Atrial fibrillation can precipitate and can be a consequence of heart failure with reduced ejection fraction and cardiomyopathy. Atrial fibrillation and heart failure, when present together, are associated with worse outcomes. Together, these 2 conditions increase the risk of stroke, requiring oral anticoagulation in many or left atrial appendage closure in some. Medical management for rate and rhythm control of atrial fibrillation in heart failure remain hampered by variable success, intolerance, and adverse effects. In multiple randomized clinical trials in recent years, catheter ablation for atrial fibrillation in patients with heart failure and reduced ejection fraction has shown superiority in improving survival, quality of life, and ventricular function and reducing heart failure hospitalizations compared with antiarrhythmic drugs and rate control therapies. This has resulted in a paradigm shift in management toward nonpharmacological rhythm control of atrial fibrillation in heart failure with reduced ejection fraction. The primary objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology and pathophysiology of atrial fibrillation in relation to heart failure and to provide guidance on the latest advances in pharmacological and nonpharmacological management of atrial fibrillation in patients with heart failure and reduced ejection fraction. The writing committee’s consensus on the implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.

中文翻译：

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心力衰竭和射血分数降低患者的房颤管理：美国心脏协会的科学声明

心房颤动和射血分数降低的心力衰竭在世界范围内的患病率正在增加。心房颤动可以沉淀，并且可能是射血分数降低的心力衰竭和心肌病的结果。心房颤动和心力衰竭同时存在时，结局更差。这 2 种情况共同增加了中风的风险，许多情况下需要口服抗凝剂，一些情况下需要关闭左心耳。心力衰竭中心房颤动的心率和节律控制的医疗管理仍然受到不同成功率、不耐受和不良反应的阻碍。近年来多项随机临床试验中，导管消融治疗射血分数降低的心力衰竭患者房颤在提高生存率、生活质量、和心室功能，并与抗心律失常药物和心率控制疗法相比减少心力衰竭住院。这导致射血分数降低的心力衰竭心房颤动的管理范式转变为非药物节律控制。这份美国心脏协会科学声明的主要目的是审查与心力衰竭相关的心房颤动的流行病学和病理生理学的现有证据，并为心力衰竭患者心房颤动的药物和非药物治疗的最新进展提供指导并降低射血分数。突出了编写委员会对临床实践的影响、知识差距和未来研究方向的共识。