Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions

Heart Fail Rev. 2022 Jul;27(4):1201-1210. doi: 10.1007/s10741-021-10133-6. Epub 2021 Jul 4.

Abstract

A bidirectional pathophysiological link connects heart failure and atrial fibrillation, creating a frequent and challenging comorbidity, which includes neurohormonal hyperactivation, fibrosis development, and electrophysiologic remodeling, while they share mutual risk factors. Management for these devastating comorbidities includes most of the established treatment measures for heart failure as well as rhythm or rate control and anticoagulation mostly for atrial fibrillation, which can be achieved with either pharmaceutical or non-pharmaceutical approaches. The current manuscript aims to review the existing literature regarding the underlying pathophysiology, to present the novel trends of treatment, and to predict the future perspective of these two linked diseases with the numerous unanswered questions.

Keywords: Anticoagulation; Atrial fibrillation; Heart failure; Rate control; Rhythm control; Treatment.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation* / therapy
  • Heart Failure* / epidemiology
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Heart Rate / physiology
  • Humans
  • Risk Factors

Substances

  • Anti-Arrhythmia Agents