|Heart failure is also known as congestive
heart failure (CHF) or congestive cardiac failure (CCF). It may
be confused with heart attack.
Causes of HF may include heart attack (myocardial infarction)
and other conditions such as high blood pressure, valvular heart
disease, cardiomyopathy and AF-related rapid heartbeat.
Thanks to modern day treatments, many patients with HF will feel
pretty normal performing everyday activities, but upon exertion,
tiredness can come on much sooner than usual.
For a variety of reasons, occurrence of AF becomes much more likely
in someone who has HF.
The combination of AF and heart failure exacerbates the heart’s
ability to pump effciently further, and this may make the su?erer
feel even worse.
The presence of AF increases the risk of someone suffering a
stroke. When AF and heart failure are seen in the same person,
this risk becomes much higher. If you are known to have AF together
with heart failure, you and your clinician should discuss anticoagulation
(sometimes known as blood thinning) to reduce the stroke risk.
AF in otherwise normal hearts can be diffcult to treat because
it is very patient-specific, but there are several medication
and/or procedural options which are available to treat this condition.
With heart failure, AF becomes more diffcult and risky to treat,
and some of these drugs and procedures may even cause deterioration.
Thus, AF in association with heart failure causes real problems
• increasing symptoms
• increasing risk of strokes
• being more diffcult to treat, with lower success rates
and higher risks associated with treatments.
In the UK, cardiologists recognise AF and HF as a new ‘epidemic’
following an increase in
diagnoses, and with cases set to rise in the future.
Whilst the combination of having AF and HF is a challenge, it
is not all doom and gloom.
Certainly, when AF first strikes a heart failure patient, the
sudden change in heart rate and effciency can make the patient
feel terrible and may even provoke a stay in hospital.
However, once balanced out, the outlook can be significantly better.
There are many specialist treatments that might be ordered, but
because these depend on
specific and complex details, and every patient is different,
patients should not feel disappointed if they do not qualify for
some of these strategies.
Lifestyle changes such as stopping smoking, light exercise and
dietary adjustments can alleviate HF.
Some treatments are still regarded as experimental at the time
of writing. The following may be considered appropriate:
• cardioversion, usually in combination with powerful
• insertion of a pacemaker or ventricular assist devices
• pacemaker combined with ablation of the AV node (“ablate
• Ablation, to address the AF.
The important point is that if a patient with HF develops AF,
they should be assessed reasonably rapidly, even if they feel
relatively well, as changes in treatment will almost certainly
Further information can be found in AF Association information
• Pacemaker and AV Node Ablation for AF patient information
• Ablation for atrial fibrillation patient information
• Cardioversion of atrial fibrillation patient information