William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, UK.
Europace. 2020 Nov 1;22(11):1609-1618. doi: 10.1093/europace/euaa214.
The aetiology of atrial fibrillation (AF) remains poorly understood, despite its growing prevalence and associated morbidity, mortality, and healthcare costs. Obesity is implicated in myriad different disease processes and is now recognized a major risk factor in the pathogenesis of AF. Moreover, the role of distinct adipose tissue depots is a matter of intense scientific interest with the depot directly surrounding the heart-epicardial adipose tissue (EAT) appearing to have the greatest correlation with AF presence and severity. Similarly, inflammation is implicated in the pathophysiology of AF with EAT thought to act as a local depot of inflammatory mediators. These can easily diffuse into atrial tissue with the potential to alter its structural and electrical properties. Various meta-analyses have indicated that EAT size is an independent risk factor for AF with adipose tissue expansion being inevitably associated with a local inflammatory process. Here, we first briefly review adipose tissue anatomy and physiology then move on to the epidemiological data correlating EAT, inflammation, and AF. We focus particularly on discussing the mechanistic basis of how EAT inflammation may precipitate and maintain AF. Finally, we review how EAT can be utilized to help in the clinical management of AF patients and discuss future avenues for research.
尽管心房颤动 (AF) 的患病率不断上升，且与之相关的发病率、死亡率和医疗保健费用也很高，但人们对其病因仍知之甚少。肥胖与许多不同的疾病过程有关，现在被认为是 AF 发病机制中的一个主要危险因素。此外，不同脂肪组织沉积的作用是一个强烈的科学研究兴趣的问题，直接围绕心脏的脂肪组织——心外膜脂肪组织 (EAT) 似乎与 AF 的存在和严重程度相关性最大。同样，炎症也与 AF 的病理生理学有关，EAT 被认为是炎症介质的局部储存库。这些炎症介质很容易扩散到心房组织中，从而改变其结构和电特性。多项荟萃分析表明，EAT 大小是 AF 的一个独立危险因素，脂肪组织的扩张不可避免地与局部炎症过程有关。在这里，我们首先简要回顾一下脂肪组织解剖学和生理学，然后再讨论与 EAT、炎症和 AF 相关的流行病学数据。我们特别关注讨论 EAT 炎症如何引发和维持 AF 的机制基础。最后，我们回顾了如何利用 EAT 来帮助 AF 患者的临床管理，并讨论了未来的研究方向。
