Atrial fibrillation and congestive heart failure: cause or consequence?

Congestive heart failure and auricular fibrillation are increasingly frequent diseases, notably in elderly subjects, and have even been considered epidemic. The combination of the two diseases, even though very frequent, has a significant influence on morbidity and mortality that has long been debated: is this simply a random association or a harmful association, with reciprocal aggravation between AF and CHF? The many epidemiological, physiopathotogical, and therapeutic arguments accumulated over the last few years confirm the existence of a vicious AF/CHF circle. They have thus resulted in aggressive treatment of all cases of congestive heart failure in AF patients, but also in all instances of AF in heart failure patients, associating prevention, medical treatments, and nonmedical treatments. (C) 2008 Published by Elsevier Masson SAS.