Management of Atrial Fibrillation Across the Spectrum of Heart Failure with Preserved and Reduced Ejection Fraction

Yogesh N.V. Reddy, Barry A. Borlaug, Bernard J. Gersh

Research output: Contribution to journalReview articlepeer-review


Atrial fibrillation (AF) is the most common arrhythmia among patients with heart failure (HF), and HF is the most common cause of death for patients presenting with clinical AF. AF is frequently associated with pathological atrial myocardial dysfunction and remodeling, a triad that has been called atrial myopathy. AF can be the cause or consequence of clinical HF, and the directionality varies between individual patients and across the spectrum of HF. Although initial trials suggested no advantage for a systematic rhythm control strategy in HF with reduced ejection fraction, recent data suggest that select patients may benefit from attempts to maintain sinus rhythm with catheter ablation. Preliminary data also show a close relationship among AF, left atrial myopathy, mitral regurgitation, and HF with preserved ejection, with potential clinical benefits to catheter ablation therapy. The modern management of AF in HF also requires consideration of the degree of atrial myopathy and chronicity of AF, in addition to the pathogenesis and phenotype of the underlying left ventricular HF. In this review, we summarize the contemporary management of AF and provide practical guidance and areas in need of future investigation.

Original languageEnglish (US)
Pages (from-to)339-357
Number of pages19
Issue number4
StatePublished - Jul 26 2022


  • atrial fibrillation
  • heart failure, diastolic
  • heart failure, systolic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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