Figure 3.

Role of pericardial fat in AF promotion. DAD, delayed afterdepolarization; EAD, early afterdepolarization; see Table 1. Pericardial fat-associated factors (adipocyte expansion/infiltration, inflammatory signalling molecules, growth factors, adipokines, reactive oxygen species, and stimulation of ganglionated plexi) stimulate the development of an atrial cardiomyopathy via a wide range of mediators (inflammation, oxidative stress, mechanical, and autonomic dysfunction). The obesity-induced atrial cardiomyopathy includes a vulnerable substrate, consisting of re-entry-promoting structural, connexin, and electrical remodelling, as well as Ca²⁺-handling remodelling leading to triggered activity via early and delayed afterdepolarizations. Together, these arrhythmia mechanisms promote the initiation and maintenance of AF. IL, interleukin; MCP1, monocyte chemoattractant protein-1; TNF-α, tumour necrosis factor alpha.