Atrial fibrillation in patients with heart failure with preserved ejection fraction

Abstract

Purpose of review To review the shared pathology of atrial fibrillation and heart failure with preserved ejection fraction (HFpEF) and the prognostic, diagnostic, and treatment challenges incurred by the co-occurrence of these increasingly prevalent diseases. Recent findings Multiple risk factors and mechanisms have been proposed as potentially linking atrial fibrillation and HFpEF, with systemic inflammation more recently being invoked. Nonvitamin K oral anticoagulants, left atrial appendage occlusion devices, and catheter ablation have emerged as alternative treatment options. Other novel pharmacological agents, such as neprilysin inhibitors, need to be studied further in this patient population. Summary Atrial fibrillation and HFpEF commonly co-occur because of their shared risk factors and pathophysiology and incur increased morbidity and mortality relative to either condition alone. Although the presence of both diseases can often make each diagnosis difficult, it is important to do so early in the disease course as there are now a variety of treatment options aimed at improving symptoms and quality of life, slowing disease progression, and improving prognosis. However, more research needs to be performed on the role of catheter ablation in this population. Novel pharmacologic and procedural treatment options appear promising and may further improve the treatment options available to this growing population.

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

“…Moreover, the HFpEF-Stress Trial was a prospective observational study that conducted real-time cardiac magnetic resonance exercise imaging in 75 patients with diastolic dysfunction on echocardiogram and dyspnea on exertion. The study illustrated that decompensated atrial dysfunction may act as a marker for left ventricular dysfunction and an early diagnostic sign of HFpEF [81]. Atrial dysfunction can be indicated by lower values of LA long axis strain, the distance from the mitral annulus to the most distal portion of the left atrial wall, as well as higher values of LA volume index [81].…”

“…The study illustrated that decompensated atrial dysfunction may act as a marker for left ventricular dysfunction and an early diagnostic sign of HFpEF [81]. Atrial dysfunction can be indicated by lower values of LA long axis strain, the distance from the mitral annulus to the most distal portion of the left atrial wall, as well as higher values of LA volume index [81].…”

“…Therefore, patients with AF can be misdiagnosed as having HFrEF [80]. AF also interferes with the typical modalities of assessing diastolic dysfunction because of the changes in left atrial pressures and dimensions, changes in mitral inflow patterns, and desynchrony in atrial contraction [81]. Nonetheless, there are other echocardiographic parameters that can indicate HFpEF [22].…”