Atrial fibrillation (AF) is the most common arrhythmia among patients with heart failure (HF), and HF is the most common cause of death for patients presenting with clinical AF. AF is frequently associated with pathological atrial myocardial dysfunction and remodeling, a triad that has been called atrial myopathy. AF can be the cause or consequence of clinical HF, and the directionality varies between individual patients and across the spectrum of HF. Although initial trials suggested no advantage for a systematic rhythm control strategy in HF with reduced ejection fraction, recent data suggest that select patients may benefit from attempts to maintain sinus rhythm with catheter ablation. Preliminary data also show a close relationship among AF, left atrial myopathy, mitral regurgitation, and HF with preserved ejection, with potential clinical benefits to catheter ablation therapy. The modern management of AF in HF also requires consideration of the degree of atrial myopathy and chronicity of AF, in addition to the pathogenesis and phenotype of the underlying left ventricular HF. In this review, we summarize the contemporary management of AF and provide practical guidance and areas in need of future investigation.

中文翻译：

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保留和降低射血分数的心力衰竭范围内心房颤动的管理

房颤 (AF) 是心力衰竭 (HF) 患者中最常见的心律失常，而 HF 是临床 AF 患者最常见的死亡原因。房颤通常与病理性心房心肌功能障碍和重塑有关，这是一种被称为心房肌病的三联征。AF 可能是临床 HF 的原因或结果，并且方向性在个体患者之间和整个 HF 范围内都不同。尽管初步试验表明在射血分数降低的 HF 中系统性节律控制策略没有优势，但最近的数据表明，选择患者可能受益于尝试通过导管消融维持窦性心律。初步数据还显示 AF、左心房肌病、二尖瓣反流和射血保留的 HF 之间存在密切关系，对导管消融治疗具有潜在的临床益处。除了潜在的左心室 HF 的发病机制和表型外，HF 中 AF 的现代管理还需要考虑心房肌病的程度和 AF 的慢性化程度。在这篇综述中，我们总结了 AF 的当代管理，并提供了实用指南和未来需要研究的领域。