Commentary on: Pericardial Fat is Independently Associated with Human Atrial Fibrillation by Al Chekakie et al.

Obesity is an established risk factor for atrial fibrillation (AF).1 In fact, it has been reported that the increasing prevalence of obesity in the United States could account for up to 60 % of the increasing incidence of age and sex adjusted AF.2 Adipose tissue has been shown to be highly metabolically active and secretes several proinflammatory mediators; however, different fat depots differ in metabolic and inflammatory activity.3 Pericardial fat produces several inflammatory cytokines and is believed to play an important role in cardiovascular pathology, and particularly in coronary artery disease.4-7 There exists increasing evidence that links AF and inflammation. The concentration of serum C-reactive protein (CRP), a marker of systemic inflammation, is increased in patients with AF, and has been associated with the development of new AF as well as AF persistence.8-9 Given the association of AF with central obesity and systemic inflammation, investigating the role of pericardial fat, a local fat depot with high inflammatory potential, is of interest. Al Chekakie et al.10 investigated the association of atrial fibrillation and pericardial fat.