Atrial fibrillation ablation in heart failure with reduced ejection fraction

Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are the two epidemics and present concomitantly with worse prognoses. According to the guidelines, rate control and rhythm control are the comparable selection, because rhythm control with Antiarrhythmic drugs (AADs) is not superior to rate control and anticoagulation. The CASTLE-AF trial argues the current guidelines endorse catheter ablation as first-line therapy for the treatment of AF in patients with HFrEF regardless of AF type. Late gadolinium enhancement magnetic resonance imaging scans (LGE-CMR) assessment has also been promising to regard predicting immediate efficacy and late outcomes after ablation. Selecting adequate AF patients with HFrEF, catheter ablation can result in significant improvement in LVEF, quality of life and functional status, with a survival benefit.