Professional Documents
Culture Documents
Reference # 221
Scope: Health professionals involved in the care of heart failure patients with atrial fibrillation
How should I manage my heart failure patients who have atrial fibrillation?
If the atrial fibrillation is persistent, consider electrical cardioversion recognizing that long-
standing atrial fibrillation and increased left atrial size diminish the success rate of
conversion. [Level of Evidence: Class IIa, Level B]
Rhythm control: In patients with heart failure symptoms or a decreased LVEF, avoid anti-
arrhythmic drugs except amiodarone. [Level of Evidence: Class I, Level C]
Rate control: Use the following table to guide rate control therapy
Anticoagulation: Ensure that patients with atrial fibrillation are anticoagulated unless they
have a contraindication. [Level of Evidence: Class I, Level C]
www.gacguidelines.ca -1-
CHF: Management of Patients with Heart Failure and Atrial Fibrillation
Reference # 221
Levels of Evidence
Class I Evidence or general agreement that a given procedure or treatment is beneficial, useful and
effective.
Class II Conflicting evidence or a divergence of opinion about the usefulness or efficacy of the
procedure or treatment.
Class IIa Weight of evidence is in favour of usefulness or efficacy.
Class IIb Usefulness or efficacy is less well established by evidence or opinion.
Class III Evidence or general agreement that the procedure or treatment is not useful or effective and
in some cases may be harmful.
The above recommendations were derived from the following GAC endorsed
guideline:
Arnold, J.M.O., Liu, P., Demers, C. et al. and the Canadian Cardiovascular Society. (2006, January). Canadian
Cardiovascular Society consensus conference recommendations on heart failure 2006: Diagnosis and management.
Canadian Journal of Cardiology, 22(1), 23-45.
www.gacguidelines.ca -2-