The role of obesity in the development of atrial fibrillation: current problem status

Abstract

Atrial fibrillation (AF) is one of the most common heart rhythm disorders. AF worsens the quality of life of patients and increases the risk of fatal cardiovascular complications. Obesity is a worldwide epidemic which prevalence has doubled in the past 30 years. The role of obesity as one of the predisposing factors for AF is currently being discussed. The modern literature describes several mechanisms of the influence of overweight on the development of arrhythmias: activation of the sympatho-adrenal nervous system, increased activity of the reninangiotensin-aldosterone system, development of arterial hypertension, insulin resistance, and lipid metabolism. Despite the large number of studies in this area, the pathogenesis of the development and progression of AF in obesity is not fully understood. The molecular mechanisms of AF development in obese patients include the occurrence of systemic inflammation. The most significant inflammatory activity is observed in the epicardial adipose tissue. It is proven that pro-inflammatory cytokines and adipocyte dysfunction negatively influence over development of AF. Evaluation of the patient’s clinical status and study of subtle mechanisms of arrhythmogenesis in obese patients allows discussing specific approaches to treatment. This approach is consistent with modern ideas about personalized medicine.