Heart Failure as a Novel Target for Treating Patients with Atrial Fibrillation

Doctor Jonathan Ariyaratnam, Adelaide University

Postdoctoral Fellowship

Years funded: 2026 - 2027

Atrial fibrillation (AF) remains the most common cardiac arrhythmia in Australia and worldwide. Despite rapid advances in treatment of AF in recent years, its prevalence and associated healthcare costs continue to grow exponentially. I have previously shown that almost three-quarters of patients with AF demonstrate coexistent subclinical heart failure with preserved ejection fraction (HFpEF) based on invasive measurements of cardiac pressures. Despite the absence of overt features of clinical heart failure, patients with AF and subclinical HFpEF demonstrate worse exercise capacity, higher symptom burden and poorer quality of life. The presence of subclinical HFpEF in patients with AF is hugely under-recognised by clinicians and potentially offers a novel target for treatment in patients with AF.

The aim of my fellowship program is to investigate whether the treatment of patients with AF can be improved by targeting subclinical HFpEF. I plan two small randomised studies to determine whether proven HFpEF therapies (SGLT2-inhibitors and beta-blocker withdrawal) can improve exercise capacity, symptom burden and quality of life in patients with AF and subclinical HFpEF. In addition, I plan a third observational study to determine whether AF ablation therapy, an established treatment for AF, improves or worsens HFpEF in patients with AF. In addition to providing new data regarding novel HFpEF therapies in AF, these studies will also provide unique mechanistic data regarding the presence, progression and reversal of subclinical HFpEF, through incorporation of unique techniques and protocols that I have established at our centre, including invasive haemodynamic assessment as well as advanced non-invasive cardiac imaging at rest and during exercise.