Heart Failure in Atrial Fibrillation　― An Update on Clinical and Echocardiographic Implications ―

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in adults and has unfavorable consequences such as stroke, heart failure (HF), and death. HF is the most common adverse event following AF and the leading cause of death. Therefore, identifying the association between AF and HF is important to establish risk stratification for HF in AF. Recent studies suggested that left atrial and ventricular fibrosis is an important link between AF and HF, and the prognostic impact may differ with respect to HF subtype, stratified with left ventricular ejection fraction (EF). Mortality risk in patients with concurrent AF and HF with reduced EF (HFrEF) appears slightly higher compared with those with concurrent AF and HF with preserved EF (HFpEF). On the other hand, the prognostic impact of HF in AF is similar between HFrEF and HFpEF. Further, left atrial size, as well as left atrial and left ventricular functional assessment, are reported to be useful for the prediction of HF in AF, incremental to the conventional risk factors. In this review, we focus on the epidemiological, pathophysiological, and prognostic associations between AF and HF, and review the clinical and echocardiographic predictors for HF in AF.

Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation

“…Similarly, Meleze et al reported that AFCL was associated with structural remodeling of the right atrium in an intra-atrial electrogram study [17]. Several investigations have demonstrated an association of a larger right atrial volume index and a higher incidence of AF with a higher mortality rate in patients with HF and a reduced left ventricular ejection fraction [16,[18][19][20][21].…”

“…Prolonged AFCL was also found to be related to left atrial enlargement and atrial fibrosis evaluated by delayed enhancement in magnetic resonance images [9,15]. Several reports have shown that structural remodeling, such as atrial fibrosis and left atrial enlargement, is associated with MACCE in patients with AF [16]. Similarly, Meleze et al reported that AFCL was associated with structural remodeling of the right atrium in an intra-atrial electrogram study [17].…”

Interleukin-6 Could Be a Potential Prognostic Factor in Ambulatory Elderly Patients with Stable Heart Failure: Results from a Pilot Study

“…These data are supported by the finding of inflammatory infiltrates with the presence of inflammatory cytokines (IL-1, IL-6, and TNFα), myocyte necrosis, and fibrosis in atrial biopsies of patients with AF. Furthermore, fibrotic changes in the left atrium have been shown to be an important link between atrial fibrillation and the development of heart failure [35][36][37]. There are even studies that indicate that left ventricular fibrosis quantified by T1 mapping using cardiac MRI can be a potential predictor of adverse events in patients with HF and coexisting AF [38].…”

Cardiac Conduction Velocity, Remodeling and Arrhythmogenesis

“…Major arrhythmic events (such as atrial fibrillation or ventricular tachycardia) have profound effects on quality of life and mortality. Atrial fibrillation, for example, affects more than 30 million people worldwide and will be increasingly prevalent with aging populations [ 1 ]. Atrial fibrillation often leads to adverse consequences, such as stroke and heart failure (HF), increasing mortality [ 2 ].…”