Obesity and atrial fibrillation: A comprehensive review of the pathophysiological mechanisms and links

Abstract

Obesity is a worldwide health problem with epidemic proportions that has been associated with atrial fibrillation (AF). Even though the underlying pathophysiological mechanisms have not been completely elucidated, several experimental and clinical studies implicate obesity in the initiation and perpetuation of AF. Of note, hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease, and obstructive sleep apnea, represent clinical correlates between obesity and AF. In addition, ventricular adaptation, diastolic dysfunction, and epicardial adipose tissue appear to be implicated in atrial electrical and structural remodeling, thereby promoting the arrhythmia in obese subjects. The present article provides a concise overview of the association between obesity and AF, and highlights the underlying pathophysiological mechanisms.

Endothelial–mesenchymal transition in human atrial fibrillation

“…Atrial structural remodeling, particularly fibrosis in which fibroblasts play a key role, is important in many forms of AF [8,9,10]. In our study population, the amount of fibrotic deposition in LA was correlated with LAD, which is a strong predictor of recurrence of AF after catheter ablation or drug therapy [2,11].…”

The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population — a cross-sectional analysis of medical documentation

“…Recently, there has been an increase in interest concerning the association between nutritional status and AF [1,2]. The potential relationships between this cardiac arrhythmia and both over-and undernutrition have epidemiological and pathophysiological bases [2,3]. Obesity or overweight, which, according to the POLSCREEN study, affects about 70% of the Polish population, acts as a risk factor for CV diseases (CVD) but is, on the other hand, in an obesity paradox mechanism, associated with reduced CV mortality among patients with AF [2,4,5].…”

Inflammation of left atrial epicardial adipose tissue is associated with paroxysmal atrial fibrillation

“…Obesity as defined by body mass index (BMI) is one of the risk factors for developing AF, as are advanced age, diabetes, hypertension, and coronary artery disease (CAD) [2][3][4][5]. Ectopic fat deposits in muscle, liver, and the pancreas correlate with insulin resistance and CAD [4].…”