Atrial fibrillation and heart failure with preserved ejection fraction: diagnostic challenges and therapeutic opportunities

Heart failure with preserved ejection fraction (HFpEF) is a syndrome characterised by cardiac and non-cardiac physiologic disturbances, commonly underpinned by cardiometabolic abnormalities, which culminate in elevated left ventricular filling pressures and progressive symptoms of exercise intolerance. Arrhythmias, particularly atrial fibrillation (AF), are common in HFpEF and have important clinical implications. AF complicates the diagnosis and management of HFpEF. In this review, we synthesise the impact of AF on disease detection, symptom burden and prognosis and HFpEF treatment. Furthermore, we review pharmacological and interventional therapies that may mitigate the risk of AF and improve how patients with HFpEF feel, function and survive.