Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of eithe...Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of either condition can‘cause’the development of the other,creating a new patient group that demands different management strategies to that if they occur in isolation.Regardless of the temproral association of the two conditions,their presence is linked with adverse cardi-ovascular outcomes,increased rate of hospitalizations,and increased economic burden on healthcare systems.The use of low-cost,easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and HF.Both AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic information.These will then guide patient centred therapeutic management.The current biomarkers that offer potential for guiding therapy,focus on the physiological pathways of miRNA,myocardial stretch and injury,oxidative stress,inflammation,fibrosis,coagulation and renal impairment.Each of these has different utility in current clinincal practice.展开更多
Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both...Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.展开更多
文摘Atrial fibrillation(AF)and heart failure(HF)are two cardiovascular diseases with an increasing prevalence worldwide.These conditions share common pathophysiologiesand frequently co-exit.In fact,the occurrence of either condition can‘cause’the development of the other,creating a new patient group that demands different management strategies to that if they occur in isolation.Regardless of the temproral association of the two conditions,their presence is linked with adverse cardi-ovascular outcomes,increased rate of hospitalizations,and increased economic burden on healthcare systems.The use of low-cost,easily accessible and applicable biomarkers may hasten the correct diagnosis and the effective treatment of AF and HF.Both AF and HF effect multiple physiological pathways and thus a great number of biomarkers can be measured that potentially give the clinician important diagnostic and prognostic information.These will then guide patient centred therapeutic management.The current biomarkers that offer potential for guiding therapy,focus on the physiological pathways of miRNA,myocardial stretch and injury,oxidative stress,inflammation,fibrosis,coagulation and renal impairment.Each of these has different utility in current clinincal practice.
文摘Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.
