Atrial fibrillation in patients with heart failure with preserved ejection fraction

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.
Source: Current Opinion in Cardiology - Category: Cardiology Tags: CARDIAC FAILURE: Edited by Rebecca Cogswell and Gene Kim Source Type: research

Related Links:

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age>75 years, diabetes mel...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research
Conclusions: The decision to use anticoagulants for stroke prevention was based on the type of atrial fibrillation, rather than on the risk of stroke as quantified by CHA2DS2-VASc as per the recommended guidelines.
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
The most common form of sustained cardiac arrhythmia, which is characterized by irregular heartbeats, is atrial fibrillation (AF). The maintenance of AF is mediated by changes in the atrial structural and electrical properties.1 AF is a major risk factor for ischemic stroke and heart failure,2,3 which are associated with enhanced morbidity, mortality, and socioeconomic burden.4 The prevalence of AF is estimated to markedly increase as the population ages. Therefore, it is important to elucidate the molecular mechanisms underlying AF.
Source: Heart and Lung - Category: Intensive Care Authors: Source Type: research
Abstract Atrial fibrillation (AF) represents the most common arrhythmia worldwide, and its prevalence exponentially increases with age. It is related to increased risk of ischemic stroke or systemic embolism, which determines a significant burden of morbidity and mortality, as widely documented in the literature. AF also constitutes a risk factor for other less investigated conditions, such as heart failure, pulmonary embolism, impairment in physical performance, reduced quality of life and development of disability, mood disorders, and cognitive impairment up to dementia. In the elderly population, the management...
Source: Ageing Research Reviews - Category: Genetics & Stem Cells Authors: Tags: Ageing Res Rev Source Type: research
Conclusions: In HFpEF patients associated with AF, beta-blocker treatment is associated with significantly lower all-cause mortality, but it increased the risk of rehospitalization due to heart failure. PMID: 32454997 [PubMed]
Source: Cardiology Research and Practice - Category: Cardiology Authors: Tags: Cardiol Res Pract Source Type: research
Conclusions: AD and CVD are frequently associated. Further studies are needed in order to understand the effect of CVD and its risk factors on AD in order to better comprehend the effects of subclinical and clinical CVD on the brain. Finally, we need to clarify the impact of the underlying hypothesized mechanisms of this association and to investigate gender issues. PMID: 32454996 [PubMed]
Source: Cardiology Research and Practice - Category: Cardiology Authors: Tags: Cardiol Res Pract Source Type: research
AbstractHeart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney dis...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
AbstractChronic RV pacing may lead to pacing induced cardiomyopathy in some patients and results in a higher risk of development of LV systolic dysfunction, heart failure, mitral regurgitation and atrial fibrillation. His bundle pacing emerged as the most physiologic form of ventricular pacing. However, wide adoption of this technique in routine clinical practice is limited by higher capture thresholds at implant sometimes, lower R wave amplitudes, atrial over sensing and increased risk for late rise in pacing thresholds (resulting in the need for lead revisions). Some recent studies have focused on left bundle branch area...
Source: Heart and Vessels - Category: Cardiology Source Type: research
AbstractAimsThe aim of this study was to investigate the diagnostic and prognostic utility of the QRS ‐T angle, an electrocardiogram (ECG) marker quantifying depolarization–repolarization heterogeneity, in patients with suspected acute decompensated heart failure (ADHF).Methods and resultsWe prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of ADHF. The QRS ‐T angle was automatically derived from a standard 12‐lead ECG recorded at presentation. The primary diagnostic endpoint was a final adjudicated diagnosis of ADHF. The primary prognostic endpoint was a...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
AbstractPurpose of reviewIn this review article, we aim to describe the pathophysiology of concomitant atrial fibrillation and both left and right heart failure, as well as pronounce the prognosis of having these two conditions simultaneously. This review also summarizes the current management of atrial fibrillation including stroke and thromboembolism prevention in the presence of systolic and diastolic heart failure.Recent findingsWhile rhythm control strategy is not superior to rate control strategy in atrial fibrillation patients without heart failure, catheter ablation for atrial fibrillation has shown to improve outc...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
More News: Atrial Fibrillation | Cardiology | Genetics | Heart | Heart Failure | Pathology