Epicardial adipose tissue as a substrate for atrial structural remodeling in atrial fibrillation
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with its prevalence rising significantly with age.
It is strongly linked to an elevated risk of stroke, heart failure, and cardiovascular mortality. Among the various
risk factors contributing to the onset and progression of AF, obesity and inflammation are particularly significant.
Recent studies have highlighted the role of epicardial adipose tissue (EAT), the heart’s visceral fat depot, in
the development of AF. EAT has been implicated in several arrhythmogenic mechanisms, including myocardial
inflammation, fibrosis, oxidative stress, and fat infiltration. As a local source of inflammatory mediators, EAT may
contribute to atrial collagen deposition and fibrosis, which form the structural basis for AF. Additionally, the close
anatomical relationship between EAT and the myocardium allows EAT to infiltrate the atrial tissue, potentially
altering its electrophysiological properties. These findings underscore the hypothesis that EAT plays a critical role
in both structural and electrical atrial remodeling, processes central to the initiation and progression of AF.
The quantification of EAT using imaging techniques such as echocardiography, computed tomography, and
cardiac magnetic resonance has been proposed as a valuable prognostic tool for predicting the presence, severity,
and recurrence of AF. Moreover, EAT is increasingly being recognized as a promising therapeutic target. This
descriptive review aims to summarize the latest data on the role of EAT in the pathogenesis of AF, the mechanisms
through which EAT contributes to atrial remodeling, and the potential of modern imaging techniques for its
assessment. This review aims to provide an overview of recent evidence on the role of EAT in the pathogenesis
of AF, the mechanisms through which EAT promotes atrial remodeling, and the potential therapeutic strategies
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