ABSTRACT
Atrial fibrillation (AF) is highly prevalent in heart failure (HF) and is associated with impaired cardiac hemodynamics and adverse outcomes, especially in the setting of HF with preserved ejection fraction (HFpEF). HF and AF share many common risk factors while pathophysiologic alterations in HF such as hemodynamic abnormalities, neurohormonal activation, inflammation, and oxidative stress lead to atrial structural and electrophysiological remodeling promoting AF. The main goal of treatment in patients with HF and AF is to prevent thromboembolic complications as well as to improve symptoms and quality of life. Apart from the use of anticoagulation and rate control agents, early rhythm control before the development of extensive atrial remodeling may have favorable effects. Antiarrhythmic drugs have several shortcomings, especially in the setting of HF. On the other hand, effective rhythm control with AF ablation significantly reduces morbidity and mortality. Moreover, the adoption of HF optimal medical therapy, lifestyle modifications, as well as the aggressive management of comorbidities such as obesity, sleep apnea, diabetes, and chronic kidney disease may significantly reduce AF burden.
