Obesity and atrial fibrillation: a narrative review from arrhythmogenic mechanisms to clinical significance

The prevalence of obesity and atrial fibrillation (AF), which are inextricably linked, is rapidly increasing worldwide. Obesity rates are higher among patients with AF than healthy individuals. Some epidemiological data indicated that obese patients were more likely to develop AF, but others reported no significant correlation. Obesity-related hypertension, diabetes, and obstructive sleep apnea are all associated with AF. Additionally, increased epicardial fat, systemic inflammation, and oxidative stress caused by obesity can induce atrial enlargement, inflammatory activation, local myocardial fibrosis, and electrical conduction abnormalities, all of which led to AF and promoted its persistence. Weight loss reduced the risk and reversed natural progression of AF, which may be due to its anti-fibrosis and inflammation effect. However, fluctuations in weight offset the benefits of weight loss. Therefore, the importance of steady weight loss urges clinicians to incorporate weight management interventions in the treatment of patients with AF. In this review, we discuss the epidemiology of obesity and AF, summarize the mechanisms by which obesity triggers AF, and explain how weight loss improves the prognosis of AF.

Automated summary

The prevalence of obesity and AF is rapidly increasing worldwide, with higher obesity rates among AF patients. Epidemiological data shows a potential correlation between obesity and AF, but results are inconsistent. Obesity-related factors such as hypertension, diabetes, and sleep apnea contribute to AF. Obesity can also induce atrial enlargement, inflammation, fibrosis, and electrical abnormalities, promoting AF. Weight loss has been shown to reduce the risk and improve the prognosis of AF, possibly due to its anti-fibrosis and anti-inflammatory effects. However, fluctuations in weight can offset the benefits of weight loss. Therefore, weight management interventions should be incorporated in the treatment of AF patients.