Selecting Rhythm or Rate Control in Patients with both Atrial Fibrillation and Heart Failure

Heart failure (HF) and atrial fibrillation (AF) are common co-morbidities (AF-HF).

AF-HF patients have two treatment options: rate control, where AF is not treated but drugs are used to slow the heart rate, or rhythm control, where AF is treated to restore sinus rhythm. Rate control is the first-line treatment, yet specific patient groups do much better under rhythm control. Identifying patients that will do best under rhythm control remains a significant clinical challenge.

Potential responders to rhythm control can be identified by their disease history, however, this is often unknown, or their response to treatment, which can only be observed once the therapy has been delivered.

We propose to address these challenges by developing patient specific biophysical cardiac models to infer patient history and predict patient response to treatment to inform optimal therapy selection for individual patients. Patient specific cardiac models will be used to answer three clinical questions in prospective studies.

Models will be used to predict:1) if AF led to HF, or HF led to AF in AF-HF patients where the index disease is unknown; 2) response to rhythm control therapy in AF - HF patients and 3) when rate or rhythm control is best, in specific AF - HF patients.