Left ventricular fibrosis in atrial fibrillation and heart failure with reduced ejection fraction: A comprehensive review of mechanisms, clinical implications, and therapeutic perspectives.

Atrial fibrillation and heart failure commonly coexist, and their concurrent presence is linked to worse clinical outcomes. Although the role of atrial fibrosis in shaping the atrial substrate and influencing postablation success has been described, the impact of left ventricular myocardial fibrosis remains less clearly defined. This contemporary review explores the pathogenesis of left ventricular fibrosis, imaging modalities for its detection, and the clinical implications of ventricular fibrosis for atrial fibrillation management in the setting of heart failure with reduced ejection fraction. We also highlight key knowledge gaps and outline priorities for future research to refine risk stratification and guide therapy.