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Is Heart Failure Connected to Atrial Fibrillation & Mitral Valve Disease?

Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Gorav Ailawadi, MD, Chair of Cardiac Surgery, Michigan Medicine
Page Last Updated: June 6, 2025

I just received a great question from Clay about mitral valve disease, atrial fibrillation and congestive heart failure. In his note, Clay asked me, "Hi Adam, I have congestive heart failure and mitral valve prolapse plus long-term atrial fibrillation (AFib). My question is whether-or-not congestive heart failure is connected with mitral valve prolapse? Thanks, Clay"

To answer Clay's question, I reached out to Dr. Gorav Ailawadi who is the Chief of Cardiac Surgery at Michigan Medicine. So you know, Dr. Ailawadi is a mitral valve and atrial fibrillation expert.

Dr. Gorav Ailawadi

Dr. Ailawadi Says...

In response to Clay's question, Dr. Ailawadi wrote:

Clay,

This is an excellent question. The short answer is congestive heart failure is commonly associated and caused by mitral valve disease and atrial fibrillation (AF), but the answer is a bit more complex. CHF, or congestive heart failure, is a syndrome where there is inadequate blood flow from the heart to the organs. This causes common symptoms of shortness of breath, fluid retention, and fatigue. There are many causes of CHF including valve problems, weakened ventricular function (low ejection fraction), and coronary artery disease/ myocardial infarction. We often consider it more of a symptom than anything else.

The mitral valve functions like two neighboring parachutes that open-and-close with each heart beat. Prolapse refers to the elongation of the cords of the valve (strings of the parachute). Prolapse can lead to varying degrees of valve dysfunction but in its most severe form causes severe mitral regurgitation (MR), where blood leaks from the left ventricle back to the left atrium and lungs. This causes congestion in the lungs and also causes symptoms of CHF.

Finally, AF is often caused by severe mitral regurgitation because as blood leaks it causes extra stress, pressure, and volume in the left atrium. AF even by itself can lead to symptoms of fatigue and shortness of breath.

In the past, we would suggest a patient be considered for correction of severe MR from prolapse (usually with surgical mitral repair) when they develop AF or any symptoms. Recently, however, the guidelines have changed and have become even more aggressive and recommend surgery even in asymptomatic patients if the risk is low and mitral valve repair is highly likely at experienced centers.

To summarize, the congestive heart failure, mitral valve prolapse, and atrial fibrillation are usually, but not necessarily caused by each other. Hope this helps! -- Dr. Ailawadi

Thanks Clay! Thanks Dr. Ailawadi!

I want to thank Clay for his excellent question and I would like to extend a special thanks to Dr. Ailawadi for sharing his research and clinical experiences with our patient community!

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

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