Atrial Cardiomyopathy and Atrial Fibrillation in Different Heart Failure Substrates

The incidences of AF and heart failure (HF) have been progressively increasing worldwide. These conditions exhibit a strong interdependence, with each exacerbating the other. HF is currently classified based on left ventricular ejection fraction (EF) as HF with reduced, mid-range or preserved EF (HFrEF, HFmrEF or HFpEF, respectively). Atrial cardiomyopathy, also known as atriopathy, involves structural, architectural, contractile, or electrophysiological alterations in the atria, driven by diverse mechanisms stemming from risk factors and comorbidities, including diabetes, hypertension, ischaemic and valvular heart diseases, hypertrophic and dilated cardiomyopathies, as well as various forms of HF. Emerging evidence also implicates infiltrative cardiomyopathies (e.g. cardiac amyloidosis), certain cancers, and chemotherapeutic agents in promoting both AF and HF. This review summarises key basic and translational science findings, along with their potential clinical applications, that connect shared pathophysiological substrates between HF and atrial cardiomyopathy.