Abstract:
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence is significantly higher in individuals with obesity. This association is driven by multiple interrelated pathophysiological mechanisms, including structural, electrical, and metabolic changes in the heart. Obesity contributes to AF development through atrial enlargement, fibrosis, and increased epicardial fat deposition, all of which promote atrial remodeling. Additionally, obesity is associated with systemic inflammation and oxidative stress, both of which exacerbate atrial electrical instability and increase the likelihood of AF episodes. Another key factor linking obesity and AF is increased left atrial pressure and volume due to obesity-related conditions such as hypertension, obstructive sleep apnea, and heart failure with preserved ejection fraction (HFpEF).
Obesity also complicates the management of AF. Obese individuals often experience reduced efficacy of antiarrhythmic medications and catheter ablation procedures, making rhythm control more challenging. They are also at a higher risk for stroke and thromboembolic complications.
Evidence suggests that weight loss and lifestyle modifications can significantly reduce AF burden and improve outcomes. Studies have shown that even modest weight reduction leads to improvements in atrial size, inflammation, and arrhythmia recurrence.
