Atrial fibrillation: an update on management

Atrial fibrillation carries a markedly increased risk of stroke and left ventricular dysfunction, and is associated with reduced quality of life. In light of the potential for poor outcomes and the likely understated presence of silent atrial fibrillation, opportunistic screening should be carried out in general practice. Modifying the risk factors for atrial fibrillation is the cornerstone of management with adjuvant drug therapy to help maintain sinus rhythm, control the ventricular rate and reduce the risk of cerebral thromboembolism. The need for anticoagulant therapy can be assessed by using the revised CHA2DS2-VASc score. Direct oral anticoagulants are now preferred to warfarin in those who qualify for their use. Catheter ablation is an effective option to improve survival in patients with left ventricular dysfunction. It also improves quality of life and reduces arrhythmia-related hospital admissions

How much is enough? An appraisal of high-power short-duration radiofrequency ablation for pulmonary vein isolation

Dr Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia. Dr Pathak is supported by an early‐career fellowship from the National Health and Medical Research Council of Australia

Long-term mortality in heart failure with mid-range ejection fraction: systematic review and meta-analysis

AIMS: Heart failure patients with mid‐range ejection fraction (HFmrEF) have overlapping clinical features, compared with patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We aim to perform a meta‐analysis of studies reporting long‐term outcomes in HFmrEF compared with HFrEF and HFpEF. METHODS AND RESULTS: Data from 18 eligible large‐scale studies including 126 239 patients were pooled. Patients with HFmrEF had a lower risk of all‐cause death than those with HFrEF [risk ratio (RR) = 0.92; 95% CI = 0.85–0.98; P 50% of males had higher risk of deaths with HFrEF (RR = 1.15; 95% CI = 1.04–1.26; P = 0.006). When compared with HFpEF, patients with HFmrEF had comparable risk of all‐cause death (RR = 1.02; 95% CI = 0.96–1.09; P = 0.53). Similarly, there were no differences in the 1, 2, and 3 year deaths; CV and non‐CV deaths were insignificant between HFmrEF and HFpEF. CONCLUSIONS: The results of the study support that HFmrEF has better prognosis than HFrEF but similar prognosis when compared with HFpEF. Gender disparity between studies seems to influence the results between HFmrEF and HFrEF. Transition in left ventricular ejection fraction (LVEF), which could not be addressed in the study, may play a decisive role in determining outcomes. PROSPERO review registration number CRD42021277107