Management of Atrial Fibrillation in Recipients of Cardiac Resynchronization Therapy

As atrial fibrillation (AF) and heart failure (HF) often co-exist and influence each other, the problem of appropriate AF management concerns a wide group of recipients of cardiac resynchronization therapy (CRT). Mutual correlations between AF treatment and CRT efficacy are even closer and more complex than the pure AF and HF coexistence. The AF paroxysm, with an uncontrolled and high ventricular rate, hinders the ability of CRT to deliver a sufficient percentage of effectively resynchronized ventricular paced beats, resulting in HF exacerbation, which, in turn, may promote further AF progression. In this context, the proper management of AF in patients undergoing CRT is of supreme importance. However, there is a shortage of evidence assessing different AF treatment strategies specific to this intriguing subgroup of patients. This article summarizes the current state of knowledge about the AF–CRT relationship and the efficacy of different AF treatment strategies in the context of CRT in order to provide some hints for a proper treatment.