Epicardial fat and atrial fibrillation: Current evidence, potential mechanisms, clinical implications, and future directions

Christopher X. Wong, Anand N. Ganesan, Joseph B. Selvanayagam

Research output: Contribution to journalReview article

74 Citations (Scopus)


Obesity is increasingly recognized as a major modifiable determinant of atrial fibrillation (AF). Although body mass index and other clinical measures are useful indications of general adiposity, much recent interest has focused on epicardial fat, a distinct adipose tissue depot that can be readily assessed using non-invasive imaging techniques. A growing body of data from epidemiological and clinical studies has demonstrated that epicardial fat is consistently associated with the presence, severity, and recurrence of AF across a range of clinical settings. Evidence from basic science and translational studies has also suggested that arrhythmogenic mechanisms may involve adipocyte infiltration, pro-fibrotic, and pro-inflammatory paracrine effects, oxidative stress, and other pathways. Despite these advances, however, significant uncertainty exists and many questions remain unanswered. In this article, we review our present understanding of epicardial fat, including its classification and quantification, existing evidence implicating its role in AF, potential mechanisms, implications for clinicians, and future directions for research. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Pages (from-to)1294-1302
Number of pages9
JournalEuropean Heart Journal
Issue number17
Publication statusPublished - 1 May 2017


  • Adiposity
  • Atrial fibrillation
  • Body mass index
  • Cardiac magnetic resonance imaging
  • Computed tomography
  • Echocardiography
  • Epicardial fat
  • Obesity
  • Pericardial fat
  • Visceral adipose tissue
  • Waist circumference
  • Waist-to-hip ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this