Atrial Fibrillation (AF) and Heart Failure With Preserved Ejection Fraction (HFpEF): Advances and Challenges

This state-of-the-art review is based on the Philippe Coumel Lecture in 2024 (Figure 1). It highlights the confluence of two major cardiovascular epidemics, atrial fibrillation and heart failure, with preserved ejection fraction. In these conditions, advances in electrophysiology and heart failure physiology are intertwined and are integrated in this review. This constellation of disease states has its own unique epidemiologic features, pathophysiology, experimental and clinical mechanisms; and an increasing knowledge base with respect to clinical presentation, prognostic implications, and therapeutic options from pharmacologic advances and non-pharmacologic interventions. Major advances, continuing challenges, and future directions in this condition are described in this rapidly evolving field of scientific endeavor.