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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAtrial arrhythmias are common in patients with heart failure (HF), regardless of underlying etiology. Indeed, atrial fibrillation (AF) and HF coincide (AF\/HF) in 10\u201315% of patients in class II-III HF, and each can exacerbate the other.\u003C\/p\u003E\n            \u003Cp id=\u0022p-2\u0022\u003E\u201cNeither AF or HF can be properly managed independently of each other,\u201d said Denis Roy, MD, Professor of Medicine, University of Montreal.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Earrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPharmacologic Therapy\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAtrial arrhythmias are common in patients with heart failure (HF), regardless of underlying etiology. Indeed, atrial fibrillation (AF) and HF coincide (AF\/HF) in 10\u201315% of patients in class II-III HF, and each can exacerbate the other.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\u201cNeither AF or HF can be properly managed independently of each other,\u201d said Denis Roy, MD, Professor of Medicine, University of Montreal.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Roy cited a meta-analysis by Healey and colleagues (\u003Cem\u003EJACC\u003C\/em\u003E 2005;45:1832\u20139) that surveyed 11 clinical trials and found that ACEIs and ARBs consistently reduced the risk of new or recurrent AF in HF by 28%, with similar benefits for both types of drugs.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003E\u201cWe must think of AF as a systemic disease,\u201d Dr. Roy said. \u201cThinking in these terms will broaden decision-making, permit more comprehensive clinical strategies, and improve outcomes.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAV Nodal Ablation and Pacing\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003ERahul N. Doshi, MD, Fullerton Cardiovascular Medical Group, reviewed results from the MUSTIC AF trial, which demonstrated promising results of Cardiac Resynchronization Therapy (CRT) in patients with AF. Dr. Doshi was the principal investigator for another study, Post AV Node Ablation Evaluation (PAVE), a multicenter trial which compared the effects of biventricular pacing with conventional RV pacing in patients with normal and decreased left ventricular function. This trial confirms the data of several small single center trials on benefits of CRT in patients with AF\/HF.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EIn reviewing PAVE data, Dr. Doshi noted that in cases of chronic AF undergoing AV node ablation, \u201cbiventricular pacing should be considered the preferred mode of treatment in patients with systolic dysfunction.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAtrial Fibrillation Ablation in HF\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003E\u201cAF and HF create a vicious circle,\u201d said Li-Fern Hsu, MD, National Heart Centre, Singapore. \u201cThe two problems are intertwined, and we should consider them aspects of the same pathophysiology.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EDr. Hsu presented his review of catheter ablation for AF in HF patients, published in the \u003Cem\u003ENew England Journal of Medicine\u003C\/em\u003E in December 2004.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003E\u201cWe looked at 58 patients with HF and a LVEF \u0026lt;45% who were undergoing catheter ablation for AF (pulmonary vein isolation). We selected 58 age- and sex-matched controls without HF who were also undergoing AF ablation,\u201d Dr. Hsu said. \u201cOur findings showed that restoration and maintenance of sinus rhythm by catheter ablation\u2014without the use of drugs\u2014in patients with AF\/HF improved cardiac function, symptoms, exercise capacity, and quality of life.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cCatheter ablation for AF is clearly feasible in HF, even with coexisting structural disease,\u201d Dr. Hsu said. \u201cAnd while more studies are needed, the evidence points to maintenance of sinus rhythm for improved outcomes.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAtrial Pacing\u003C\/h2\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAfter ablation, atrial pacing is the preferred procedure for patients with AF in whom rate control is critical\u2014and for whom medications are either poorly tolerated or ineffective. Paul A. Friedman, MD, Mayo Clinic, presented several studies (Anderson et al, \u003Cem\u003ELancet\u003C\/em\u003E 1997; Tsang et al, \u003Cem\u003EJACC\u003C\/em\u003E 2002; Carlson et al, \u003Cem\u003EJACC\u003C\/em\u003E 2003), observing that device therapy (atrial pacing and defibrillation) that terminates AF will reduce hemodynamic burdens and improve outcomes. \u201cBut the current evidence does not support a recommendation for atrial defibrillation if a patient lacks an indication for an ICD,\u201d Dr. Friedman said.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl5hq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}