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Management of atrial fibrillation in patients with HFrEF

Haemodynamic

instability

Anticoagulation for preventing embolic events (Class I)

Treatment of trigger(s) (Class I)

Optimization of heart failure therapies (Class I)

OR

Beta-blockers

(Class IIa)

Digoxin/digitoxin

(Class IIa)

Amiodarone i.v.

(Class IIa)

OR

Rate control

Symptom improvement

Sinus rhythm

Amiodarone (Class IIb)

ECV (Class IIb)

Rhythm control

PV ablation (Class IIa)

ECV (Class I)

Rhythm control

OR Amiodarone (Class IIb)

Rhythm control

PV ablation (Class IIa)

AVN ablation

(Class IIb)

Rate control

Sinus rhythm

Follow-up N

N

N

Y

Y

Y

Y N

OR

OR

Figure 14 Management of atrial fibrillation in patients with heart failure with reduced ejection fraction. AF= atrial fibrillation; AVN= atrioventricular node; ECV= electrical cardioversion; HF= heart failure; i.v.= intravenous; PV= pulmonary vein. Colour code for classes of recommendation: Green for Class of recommendation I; Yellow for Class of recommendation IIa; Orange for Class of recommendation IIb; Red for Class of recommendation III (see Table 1 for further details on classes of recommendation). Downloaded from academic.oup.com/eurheartj/article/42/36/3599/6358045 by guest on 07 October 2026