The role of epicardial fat as a local mediator of atrial fibrosis

Atrial fibrillation (AF) is the most common arrhythmia in the clinical setting and associated with severe consequences. In recent years, studies on the fundamental underlying pathophysiology of AF revealed electrical, contractile and structural remodeling were synergistic contributors to AF substrate. Fibrosis was the intersection point for different remodeling processes with common endpoint of promoting and maintaining AF. Despite the fact that myocardial ischemia was consistently found to be the major preceding event for fibrosis in ventricular myocardium, there is much weaker evidence for atrial ischemia causing atrial fibrosis.