European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society

Abstract

Arrhythmias confer a substantial risk of mortality and morbidity in patients with heart failure (HF), and this represents a major healthcare burden worldwide. There are at least 15 million patients with HF in Europe alone.1 The overall prevalence of HF ranges between 2 and 3%, but increases sharply after 75 years of age, reaching 10–20% among those in the eighth decade of life.1 Heart failure hospitalizations are increasing, and many of these may be related to cardiac arrhythmias. Indeed, episodes of decompensation may be related to arrhythmias, such as atrial fibrillation (AF). Atrial fibrillation per se contributes to an increased risk of mortality and morbidity from stroke and thromboembolism, and silent AF is common among patients with HF, not infrequently leading to a first presentation of AF with an ischaemic stroke.2 New developments in stroke prevention offer additional challenges in the HF patient. Sudden cardiac death (SCD) is also a major cause of mortality among HF patients and is commonly related to cardiac arrhythmias, particularly ventricular arrhythmias (VAs).3 In addition, associated co-morbidities, such as renal impairment, may influence cardiac arrhythmias, their complications, associated treatments, and prognostic implications.4 New developments in cardiac monitoring, cardiac resynchronization therapy (CRT), and other implantable devices have been introduced. These allow better detection and treatment of cardiac arrhythmias in HF, opening more opportunities for improvements in management. To address the management of arrhythmias in HF, a Task Force was convened by the European Heart Rhythm Association (EHRA) and the Heart Failure Association (HFA), endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS), with the remit to comprehensively review the published evidence available, to publish a joint consensus document on …