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Review
. 2021 Apr 10;23(23 Suppl 2):ii40-ii45.
doi: 10.1093/europace/euaa368.

The bidirectional interaction between atrial fibrillation and heart failure: consequences for the management of both diseases

Dominique V M Verhaert  1   2 , Hans-Peter Brunner-La Rocca  1 , Dirk J van Veldhuisen  3 , Kevin Vernooy  1   2
Affiliations
Review

The bidirectional interaction between atrial fibrillation and heart failure: consequences for the management of both diseases

Dominique V M Verhaert et al. Europace. .

Abstract

Atrial fibrillation (AF) and heart failure (HF) are both highly prevalent diseases and are accompanied by a significant disease burden and increased mortality. Although the conditions may exist independently, they often go hand in hand as each is able to provoke, sustain, and aggravate the other. In addition, the diseases share a risk profile with several coinciding cardiovascular risk factors, promoting the odds of developing both AF and HF separately from each other. When the diseases coexist, this provides additional challenges but also opportunities for the optimal treatment. The recommended management of the comorbidities has been much debated in the past decades. In this review, we describe the pathophysiological coherence of AF and HF, illustrate the current knowledge on the management of them as comorbidities of each other and look forward to future developments in this field.

Keywords: Atrial fibrillation; Catheter ablation; HFpEF; HFrEF; Heart failure; Pathophysiology; Pulmonary vein isolation; Tachycardiomyopathy; Treatment.

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Figures

Figure 1
Figure 1
Pathophysiological relationship between atrial fibrillation and heart failure. AF, atrial fibrillation; HF, heart failure; RAAS, renin–angiotensin–aldosterone system.
Figure 2
Figure 2
Treatment strategies for atrial fibrillation and heart failure. AF, atrial fibrillation; CRT, cardiac resynchronization therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; ICD, implantable cardioverter-defibrillator; RAAS, renin–angiotensin–aldosterone system.
Figure 3
Figure 3
Therapy choice for atrial fibrillation and concomitant heart failure. AAD, antiarrhythmic drugs; AF, atrial fibrillation; HF, heart failure, NYHA, New York Heart Association.
See this image and copyright information in PMC

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