Management von Vorhofflimmern bei Kardiomyopathien – Rhythmuskontrolle und Antikoagulation

Atrial fibrillation (AF) and heart failure (HF) share common risk factors, comorbidities and influence each other in patients with reduced ejection fraction (HFrEF). Treatment options include anticoagulation to reduce embolic risk, modification of risk factors and rate and rhythm control strategies. In most cases long-term oral anticoagulation is recommended when AF is identified in HFrEF patients to reduce stroke risk. Novel oral anticoagulants are preferable over vitamin-k antagonists as they are safe and effective in patients with reduced left ventricular function. All HFrEF patients with AF need appropriate rate control medication. In addition, if symptoms prevail or in appropriately selected candidates rhythm control is recommended. AF ablation is superior to antiarrhythmic medical treatment and reduces mortality, HF rehospitalizations and improves functional parameters, quality of live and rhythm stability. Therefore, AF ablation is recommended in appropriate candidates but the selection criteria and optimal ablation strategy need to be identified.