Unraveling the Nexus between Obesity and Atrial Fibrillation: Mechanistic Insights and Clinical Implications

Background: The prevalence of obesity and atrial fibrillation (AF), which are inextricably linked, is rapidly increasing worldwide. Recent studies suggest that effectiveness of weight loss in reducing AF risk. Therefore, it is necessary to unravel the nexus between obesity and atrial fibrillation.

Purpose: The focus of this review is to discuss the epidemiology of obesity and AF, summarize the mechanisms by which obesity triggers AF, and emphasize how weight loss improves the prognosis of AF.

Results: Epidemiological data indicates obese patients are more likely to develop AF, but there is still controversy. The underlying mechanism of obesity leading to atrial fibrillation is quite complex. Obesity-related hypertension, diabetes, and obstructive sleep apnea are 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, 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.