Obesity and Atrial Fibrillation

The relationship between AF and obesity is undeniable.

It is a risk factor for AF.

It makes AF symptoms worse.

It makes treatments like AF ablation more dangerous and less likely to work.

The Framingham Heart Study (a long-term, multi-generational, observational study of a community) suggests that every unit increase in BMI correlated with a 4–5% increase in AF risk.

Animal studies and imaging work have suggested this relationship may be mediated by increased fat deposits surrounding the heart and releasing 'pro-AF' hormones and chemicals that drive the disease progression.

A compelling paper from an Australian group in 2021 showed a potential reversal of the AF disease pathway with weight reduction. (Reference below). Albeit, in sheep, weight increases negatively affected the shape, stiffness and fattiness of the left atrium in ways associated with AF and weight loss reversed these.

Lifestyle management is a hot area for AF research in 2022 and you're likely to see more work coming out in this area in the coming years. The International guidelines advocate lifestyle interventions like weight management as a first-line pillar in AF prevention and treatment and so if you have AF and you haven't discussed lifestyle factors with your medical team yet- please do!

Mahajan R, Lau DH, Brooks AG, Shipp NJ, Wood JPM, Manavis J, Samuel CS, Patel KP, Finnie JW, Alasady M, Kalman JM, Sanders P. Atrial Fibrillation and Obesity: Reverse Remodeling of Atrial Substrate With Weight Reduction. JACC Clin Electrophysiol. 2021 May;7(5):630-641. doi: 10.1016/j.jacep.2020.11.015. Epub 2021 Feb 24. PMID: 33640353.