Title : Obesity and cardiac arrhythmias
Obesity has been a health problem of growing significance all over the world. Numerous studies showed a relationship between obesity and cardiovascular diseases - like coronary atherosclerosis, myocardial infarction, heart failure, hypertension etc. Also numerous anatomical and functional changes in obesity play an important role in arrhythmogenesis. Obesity significantly increases the risk of atrial fibrillation (AF). The pathomechanism of AF in obesity is complex and deepens on comorbidities like hypertension, coronary artery disease, heart failure but also other mechanisms play role. The increased epicardial fat, the infiltration of myocardium with adipocytes, and fibrosis together result in a heterogeneous atrial pulse conduction. In obese patients, heightened presence of various inflammatory cytokines (C-reactive protein, IL-6, and TNF-α) may increase the local arrhythmic vulnerability of the pulmonary vein, causing AF. Successful treatment of AF episodes – conservative and invasive - in obesity is limited. At the same time, in patients with AF, there is an increased risk for cardiac death, stroke, thromboembolic complications, and heart failure.
Obesity also is considered as an independent risk factor in the development of ventricular arrhythmias and sudden cardiac death. The structural remodelling in the ventricular myocardium of obese patients results in left ventricular hypertrophy and systolic and diastolic ventricular dysfunctions. Myocardial fibrosis, focal myocardial disarray, and increased volume of epicardial fat are also parts of the pathological process. These pathological changes lead the electrical instability of cardiac cells. Furthermore, obesity may cause autonomous nervous system dysfunction. In the case of overweight patients, excessive sympathetic activity and decreased vagal tone can induce supra- and ventricular arrhythmias.
Audience Take Away:
- Influence and mechanism of arrhythmias in obesity.
- Diagnostic methods of cardiac arrhythmias.
- Problems and limitations in the arrhythmias treatment in obese patients.
- How to reduce risk of cardiac arrhythmias in obese patients.