REVIEW   

Minerva Medica 2019 April;110(2):157-67

DOI: 10.23736/S0026-4806.18.05882-2

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Atrial fibrillation in the cardiometabolic patient

Francesco DE SENSI ¹, Sarah COSTANTINO ², Ugo LIMBRUNO ¹, Francesco PANENI ^{2, 3} ✉

¹ Unit of Electrophysiology, Department of Cardiology, Misericordia Hospital, Grosseto, Italy; ² Center for Molecular Cardiology, University of Zürich, Zürich, Switzerland; ³ Unit of Cardiology, University Heart Center, University Hospital Zürich, Zürich, Switzerland

Prevalence of obesity, metabolic syndrome (MetS) and type 2 diabetes (T2D) is growing alarmingly, and the number of affected people continues to escalate. Such cardiometabolic states exert many deleterious effects on the heart as they are associated with adverse left ventricular (LV) remodeling and, most notably, with a marked increase in the risk of developing atrial fibrillation (AF) and subsequent stroke. Epidemiological studies clearly show a strong association between obesity and AF, with a 4-5% increase in AF risk for every unit increase in BMI. The increased risk of developing AF in cardiometabolic patients is explained by changes in volume status, energy substrate utilization, tissue metabolism and systemic inflammation, all factors promoting elevation in left atrial and systolic blood pressure, LV systo-diastolic dysfunction, with subsequent atrial stretch and “triggers” for AF. In the present review, we critically discuss available evidence on AF risk in the cardiometabolic patient. Specific aspects will be discussed: 1) epidemiology and prognosis of AF in patients with obesity, MetS and T2D; 2) molecular mechanisms involved in the pathophysiology of metabolic cardiomyopathy and left atrial remodeling; 3) advances in medical therapy including weight loss strategies and lifestyle changes; 4) new oral anticoagulants and stroke risk in obese and diabetic patients; 5) effectiveness and safety of AF catheter ablation. Taken together, these novel insights point to the development of new therapeutic strategies to combat the burden of AF in patients with cardiometabolic disturbances.

KEY WORDS: Atrial fibrillation - Obesity - Diabetes mellitus - Metabolic syndrome