Atrial Fibrillation-Mediated Cardiomyopathy: Mechanism, Clinical Characteristics, and Management

Atrial fibrillation (AF) and heart failure (HF) are major public health issues and are linked by a complex, bidirectional relationship. AF can contribute to the development of HF through diverse mechanisms, including tachycardia, irregular ventricular rhythm, impaired atrial contraction, and atrioventricular dyssynchronization. In patients with AF-mediated cardiomyopathy (AF-CM), these effects may be reversible with effective rate control or restoration of sinus rhythm. Early diagnosis and intervention offer the potential for the recovery of cardiac function, highlighting the importance of understanding the underlying mechanisms, clinical features, and management strategies for AF-CM. Cardiac imaging, biomarker profiling, continuous rhythm monitoring, and the identification of specific clinical features may facilitate the diagnosis of AF-CM. Catheter ablation has been established as an effective treatment for patients with AF and HF. However, considerable controversy persists regarding the necessity for long-term HF pharmacological therapy following successful ablation. In this review, the current understanding of AF-CM is summarized, with a focus on its mechanisms, clinical features, and management. The role of guideline-directed medical therapy for HF in the long-term management of patients with AF-CM is further discussed.