The role of epicardial adipose tissue in the development of atrial fibrillation: a literature review

Background. Atrial fibrillation, the most common persistent cardiac arrhythmia, is a common cause of strokes, heart failure, dementia, worsens the quality of life, increases mortality and has a significant impact on the health economy. The obesity pandemic leads to a serious increase in cardiovascular risks. Obesity is closely associated with the development of atrial fibrillation, as it is associated with diseases and conditions leading to structural and functional remodeling of the heart, as well as hypertrophy and dysfunction of epicardial adipose tissue. Epicardial fat is unique in its anatomy, extremely high secretory and metabolic activity, unobstructed proximity to the myocardium and the ability to interact with it due to the general blood flow. Under physiological conditions, epicardial adipose tissue performs a cardioprotective function. Obesity causes hypertrophy and hypoxia of adipocytes. Under these conditions, adipocytes lose their protective properties, epicardial fat mainly produces proinflammatory and profibrotic adipokines, infiltrates the myocardium, which contributes to the development of atrial fibrillation. Studies show that the thickness and volume of epicardial adipose tissue are directly correlated with the risk of atrial fibrillation, the severity of its course, and the recurrence of paroxysms after catheter ablation. Many potential mechanisms of arrhythmia induction in obesity have been discovered. Research is needed to further clarify these mechanisms and identify ways to prevent them. Taking into account the peculiarities of the structure and functions of epicardial adipose tissue, it is of interest as a promising therapeutic target.Conclusion. This article represents an overview of the most significant scientific works devoted to the problem of epicardial obesity and its relationship with atrial fibrillation, systematizes modern ideas about the potential proarrhythmogenic effect of epicardial adipose tissue, therapeutic possibilities and future prospects.