Modifiable Risk Factors in Atrial Fibrillation: Clinical Implications and Pathophysiological Insights

IF 0.9 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Noninvasive Electrocardiology Pub Date : 2026-03-02 DOI:10.1111/anec.70171

Chamath Jagoda

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引用次数: 0

Abstract

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and its growing prevalence is increasingly driven by modifiable lifestyle and clinical factors. Understanding how obesity, hypertension, diabetes, obstructive sleep apnoea (OSA), alcohol intake, and cardiorespiratory fitness each contribute to AF onset, progression, and recurrence is essential for developing comprehensive prevention and treatment strategies.

Methods

We performed a narrative review of the available literature assessing six key modifiable risk factors for AF. Evidence was synthesized regarding each factor's pathophysiological effects on atrial structure and electrophysiology, as well as the impact of targeted interventions on arrhythmia burden and procedural outcomes.

Results

Every 1 kg/m² increase in body mass index (BMI) raises AF risk by 50%, with sustained weight loss reversing atrial remodeling and improving arrhythmia-free survival. Hypertension increases atrial pressure, electrical heterogeneity, and fibrosis; resistant cases may benefit from adjunctive renal denervation. Diabetes promotes oxidative stress, profibrotic signaling, and autonomic neuropathy, reducing cardioversion success and antiarrhythmic efficacy. OSA induces intermittent hypoxia and sympathetic surges, destabilizing atrial substrates; CPAP therapy reduces remodeling and halves recurrence after cardioversion or ablation. Alcohol exerts dose-dependent ion-channel alterations, structural changes, and autonomic disruption. Cardiorespiratory fitness shows a U-shaped relationship: moderate exercise is protective, whereas endurance extremes and inactivity foster atrial stretch, fibrosis, and ectopic triggers. Across all factors, shared mechanisms of fibrosis, inflammation, and autonomic imbalance emerge as key therapeutic targets.

Conclusions

Integrating risk-factor modification into AF rhythm-control protocols addresses fundamental disease mechanisms and enhances procedural efficacy, offering clinicians a framework for prevention and therapy.

Abstract Image

查看原文本刊更多论文

心房颤动可改变的危险因素：临床意义和病理生理学见解。

背景：房颤（AF）是世界范围内最常见的持续性心律失常，其发病率的增长越来越多地受到可改变的生活方式和临床因素的驱动。了解肥胖、高血压、糖尿病、阻塞性睡眠呼吸暂停（OSA）、酒精摄入和心肺健康如何导致房颤的发作、进展和复发，对于制定全面的预防和治疗策略至关重要。方法：我们对现有文献进行了叙述性回顾，评估了房颤的六个关键可改变危险因素。综合了每个因素对心房结构和电生理的病理生理影响，以及有针对性的干预对心律失常负担和手术结果的影响。结果：体重指数（BMI）每增加1 kg/m2，房颤风险增加50%，持续体重减轻可逆转心房重构并改善无心律失常生存。高血压增加心房压、电异质性和纤维化；顽固性病例可能受益于辅助肾去神经。糖尿病促进氧化应激、纤维化信号和自主神经病变，降低心律转复成功率和抗心律失常的疗效。OSA诱导间歇性缺氧和交感神经激增，破坏心房底物的稳定；CPAP治疗可减少心律转复或消融后的重塑和复发。酒精产生剂量依赖性离子通道改变、结构改变和自主神经紊乱。心肺健康呈u型关系：适度运动具有保护作用，而耐力极限和不运动则会促进心房拉伸、纤维化和异位触发。在所有因素中，纤维化、炎症和自主神经失衡的共同机制成为关键的治疗靶点。结论：将危险因素调整纳入心律失常控制方案，解决了基本的疾病机制，提高了程序疗效，为临床医生提供了预防和治疗的框架。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.