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Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction: New Insights and Unresolved Questions
Andreas A Boehmer1, Joachim R Ehrlich2, Stanley Nattel3
1Department of Cardiology, St. Josefs-Hospital, Wiesbaden, Germany; Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
JACC. Clinical Electrophysiology
|November 13, 2025
Summary
Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) often coexist, worsening patient outcomes. Further research is crucial for personalized management strategies for this complex comorbidity.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) frequently coexist due to shared remodeling processes.
- This comorbidity significantly worsens patient prognosis and quality of life.
- Understanding the complex interplay between AF and HFrEF is critical for improving patient care.
Purpose of the Study:
- To review the current evidence on the interrelationships between AF and HFrEF.
- To discuss the underlying pathophysiological mechanisms.
- To highlight treatment options and identify knowledge gaps in managing this comorbidity.
Main Methods:
- This is a narrative review of existing literature.
- The review analyzes evidence regarding AF and HFrEF interrelationships, basic mechanisms, and treatment options.
Main Results:
- Catheter ablation for rhythm control has shown benefits in HFrEF patients with AF.
- Early rhythm control is important, but optimal timing, energy sources, and pharmacologic therapy require further investigation.
- Personalized management is essential but requires more research.
Conclusions:
- Significant knowledge gaps remain in understanding and managing the AF and HFrEF comorbidity.
- Continued research is needed to optimize rhythm control strategies and enable personalized patient care.
- Addressing these gaps is vital for improving outcomes in patients with both conditions.
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