Atrial fibrillation and heart failure: pathophysiological relationship, clinical manifestations, and prognostic significance

Abstract

This narrative review summarizes current evidence on the pathophysiological mechanisms, clinical manifestations, and prognostic implications of the interaction between AF and HF, emphasizing contemporary concepts and the need for an integrated diagnostic and therapeutic approach to improve clinical outcomes in this high-risk patient population. They frequently coexist and are linked by a pronounced bidirectional pathophysiological and clinical relationship. AF may contribute to the development and progression of HF through loss of atrial contribution to ventricular filling, irregular and often rapid ventricular response, and the development of tachycardia-induced cardiomyopathy. Conversely, myocardial structural and functional remodeling, hemodynamic alterations, and neurohormonal activation in HF create a favorable substrate for the initiation and maintenance of AF. The coexistence of AF and HF is associated with more severe symptoms, increased rates of hospitalization, and an adverse long-term prognosis, regardless of the HF phenotype.