According to a new hypothesis, early detection of subclinical atrial disease may provide an opportunity to prevent both atrial fibrillation and heart failure.  For primary care doctors, the theory suggests that referring patients early on for cardiovascular assessment might help avert serious illness. The researchers suggest subclinical atrial disease, which has not yet been well defined by researchers but can be identified using imaging, biomarkers, or other approaches, may be "common soil" for heart failure, atrial fibrillation, and stroke.

 Al-Khatib, who was not involved in the report said that the framework differs somewhat from how physicians and researchers typically think about heart failure and atrial fibrillation [AF]. The prevailing thinking among heart specialists is that the relationship between AF and HF is causal and bi-directional: AF can cause HF, HF can cause AF, Al-Khatib said. "The framework they are proposing is that of 'parallel trajectories activated by a common underlying myopathy that affects both the atrial and the ventricular myocardium.' While this concept is not entirely novel, it is more explicitly described in this report."

Al-Khatib and her colleagues previously outlined priorities for studying the "complex interrelations" between AF and HF, which they had discussed during a workshop hosted by the US National Heart, Lung, and Blood Institute in 2019.

"AF and HF are closely intertwined, with each condition predisposing to the other," they wrote in June 2020 in Circulation. Still, doctors have a limited understanding as to whether HF after AF occurs because of shared underlying mechanisms, with a common pathobiology of AF and HF. In contrast, there may also be hemodynamic and other triggers for cardiac remodeling that are specifically driven by AF and make progression to HF more likely.



Disease Condition ,Heart Failure,Arrhythmias,Atrial Fibrillation