Abstract
The rising epidemic of atrial fibrillation (AF) can partly be explained by the pandemics of obesity and metabolic syndrome, which are established risk factors for both AF onset and progression. 1 Abed H.S. Wittert G.A. Leong D.P. et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013; 310: 2050-2060 Crossref PubMed Scopus (456) Google Scholar Adipose tissue around the atria is known to be a major source of adipokines, inflammatory cytokines, and reactive oxidative species, which are hypothesized to contribute to fibrotic remodeling of the atrial myocardium, leading to structural and functional remodeling and AF. 2 Hatem S.N. Redheuil A. Gandjbakhch E. Cardiac adipose tissue and atrial fibrillation: the perils of adiposity. Cardiovasc Res. 2016; 109: 502-509 Crossref PubMed Scopus (77) Google Scholar This provides an opportunity to treat AF with risk factor management, which may reduce AF burden or even eliminate AF. 1 Abed H.S. Wittert G.A. Leong D.P. et al. Effect of weight reduction and cardiometabolic risk factor management on symptom burden and severity in patients with atrial fibrillation: a randomized clinical trial. JAMA. 2013; 310: 2050-2060 Crossref PubMed Scopus (456) Google Scholar ,3 Pathak R.K. Middeldorp M.E. Meredith M. et al. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol. 2015; 65: 2159-2169 Crossref PubMed Scopus (561) Google Scholar ,4 Gessler N. Willems S. Steven D. et al. Supervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial. Europace. 2021; 23: 1548-1558 Crossref PubMed Scopus (13) Google Scholar However, the impact of risk factor modification has been shown to vary among patients, 3 Pathak R.K. Middeldorp M.E. Meredith M. et al. Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: a long-term follow-up study (LEGACY). J Am Coll Cardiol. 2015; 65: 2159-2169 Crossref PubMed Scopus (561) Google Scholar , 4 Gessler N. Willems S. Steven D. et al. Supervised Obesity Reduction Trial for AF ablation patients: results from the SORT-AF trial. Europace. 2021; 23: 1548-1558 Crossref PubMed Scopus (13) Google Scholar , 5 Alonso A. Bahnson J.L. Gaussoin S.A. et al. Effect of an intensive lifestyle intervention on atrial fibrillation risk in individuals with type 2 diabetes: the Look AHEAD randomized trial. Am Heart J. 2015; 170: 770-777.e5 Crossref PubMed Scopus (66) Google Scholar and it is important to identify subgroups of patients in whom such mechanisms are central. Unsupervised machine learning reveals epicardial adipose tissue subtypes with distinct atrial fibrosis profiles in patients with persistent atrial fibrillation: A prospective 2-center cohort studyHeart RhythmVol. 19Issue 12PreviewEpicardial adipose tissue (EAT) accumulation is associated with the progression of atrial fibrillation. However, the histological features of EATs are poorly defined and their correlation with atrial fibrosis is unclear. Full-Text PDF
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