DOI: https://doi.org/10.36347/sasjm.2026.v12i05.009

Pages: 412-418

Introduction: Atrial fibrillation (AF) and heart failure (HF) represent two intrinsically interrelated entities, each promoting the development and exacerbation of the other. Their coexistence exposes patients to an increased risk of cardiovascular morbidity and mortality. The objective of this study was to analyze the impact of AF on the clinical, hemodynamic, and etiological profile of patients hospitalized for heart failure. Methods: This retrospective, descriptive, and analytical study was conducted between January 2022 and December 2024 at the Mohammed VI University Hospital Center (CHU) in Marrakech. It included 321 patients hospitalized or followed for documented HF. Characteristics were compared between patients with AF (AF+ group, n=104) and those in sinus rhythm (AF– group, n=217). Results: The prevalence of AF at admission was 32.4%. Patients in the AF+ group were significantly older (63.8 vs. 59.9 years; p=0.013) and had a higher prevalence of hypertension (49.0% vs. 26.3%; p<0.0001) and obesity (19.2% vs. 6.5%; p=0.001). Clinically, severe dyspnea (NYHA III–IV) and right ventricular failure predominated in the AF+ group. Paradoxically, the mean left ventricular ejection fraction (LVEF) was higher in the presence of AF (36.4% vs. 33.7%; p=0.039), with a higher prevalence of HF with preserved ejection fraction (HFpEF: 22% vs. 8.2%) and near-universal left atrial dilatation (84%). Ischemic cardiomyopathy predominated in sinus rhythm (69%), while valvular (26.9%) and arrhythmia-induced etiologies (8.7%) were significantly more frequent in the AF+ group. Conclusion: AF imparts a distinctive clinical and hemodynamic imprint characterized by a more severe presentation and a specific etiological profile, underscoring the central role of atrial myopathy.