Correlation between Atrial Fibrillation and Heart Failure with Preserved Ejection Fraction: A Review

Abstract

Previous studies have demonstrated that patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) may develop the latter. The prevalence of 20-43% for AF in patients with HFpEF and prevalence of 50- 60% for HFpEF in AF patients. The pathophysiology indicates that AF usually precedes HFpEF, but each disease can promote the progression of the other one. Multiple mechanisms have been posited, such as left atrial (LA) fibrosis and myopathy as well as volume/pressure overload. Moreover, the combination of AF and HFpEF is associated with an increased rate of mortality as the presence of AF worsens the hemodynamics of HF. The diagnosis of HFpEF in patients with AF is underestimated, as the symptoms, laboratory values, and imaging techniques can be skewed by the presence of AF. Unfortunately, there are limited randomized controlled trials that recommend guideline-based treatments, such as choosing between rate and rhythm control. This narrative review aims to illustrate and summarize the pathophysiology, diagnosis, and treatment in the current literature for patients with AF and HFpEF.