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Pathophysiology of concomitant atrial fibrillation and heart failure: implications for management

Nature Clinical Practice Cardiovascular Medicine volume 6, pages 46–56 (2009)Cite this article

Abstract

Atrial fibrillation (AF) and heart failure (HF) are two conditions regularly encountered in clinical practice. They share many common risk factors, and are often seen concurrently in an individual patient. Global aging of the population is likely to lead to an increase in the prevalence of both AF and HF alone, as well as in their combined state. The relationship between these two diseases is not simply coincidental; clinical and experimental data have defined multiple pathophysiological mechanisms to explain how either condition contributes to the de novo development of the other. The development of AF in the setting of HF, and vice versa, is associated with clinical deterioration and worsening prognosis, which indicates the need for an improved understanding of the clinical and pathological relationships between these conditions. Future research on pharmacologic therapies, such as antiarrhythmic medications, and nonpharmacologic strategies including atrioventricular nodal ablation and pulmonary vein isolation, will help to define the optimal therapeutic approach for concurrent AF and HF. This step is vital to improve both the outcomes of patients affected by these conditions and the cost-effectiveness of their care.

Key Points

  • Atrial fibrillation and heart failure are common cardiac pathologies; they share risk factors, affect similar populations of patients, and often occur together

  • The changing epidemiology of atrial fibrillation and heart failure, combined with changing patient demographics, set the stage for the current epidemic of cardiovascular disease

  • The pathophysiological interaction between atrial fibrillation and heart failure is complex; various mechanisms have been proposed to explain each as a cause or consequence of the other

  • Although achievement of sinus rhythm is associated with improved survival in patients with atrial fibrillation and heart failure, this benefit does not persist when rhythm control strategies are pursued

  • Nonpharmacologic therapies for atrial fibrillation, including atrioventricular nodal ablation and pulmonary vein isolation, have shown promising results and ongoing trials will further define the role of these procedures in the treatment of atrial fibrillation and heart failure

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Figure 1: Mechanisms of atrial-fibrillation-induced heart failure.
Figure 2: Mechanisms of heart-failure-induced atrial fibrillation.
Figure 3: Treatment strategies for patients affected by both atrial fibrillation and heart failure.

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Authors and Affiliations

  1. in the Division of Cardiovascular Diseases, Department of Internal Medicine, TB Morrison is a second year resident in the Internal Medicine Residency Training program, and BJ Gersh is Professor of Medicine, Mayo Clinic, Rochester, MN, USA.,

    T Ben Morrison & Bernard J Gersh

  2. TJ Bunch is a member of the Intermountain Heart Rhythm Specialists at the Intermountain Medical Center in Murray, UT, USA.,

    T Jared Bunch

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  1. T Ben Morrison
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Correspondence to Bernard J Gersh.

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Ben Morrison, T., Jared Bunch, T. & Gersh, B. Pathophysiology of concomitant atrial fibrillation and heart failure: implications for management. Nat Rev Cardiol 6, 46–56 (2009). https://doi.org/10.1038/ncpcardio1414

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