Obesity is a known cardiovascular risk factor and it increases the risk of cardiac arrhythmias and sudden cardiac death. The most commonly reported arrhythmias are atrial fibrillation and ventricular tachycardia. The present review focuses on the mechanisms linking overweight and obesity with cardiac arrhythmias and provides a brief review of the latest studies in this area. Obesity is one of the very few identified modifiable risk factors for the occurrence and progression of atrial fibrillation, and the mechanisms linking atrial fibrillation and obesity include: structural and electrophysiological atrial remodeling, metabolic factors, sympatho-vagal imbalance, clinical links (obstructive sleep apnea, cardiovascular comorbidities) and inflammation. The main mechanisms leading to ventricular arrhythmia and sudden cardiac death in obese individuals include cardiomyopathy, metabolic factors, sympathetic hyperinnervation, obesity-induced electrophysiological remodeling, coronary heart disease as common comorbidity and radical weight reduction strategies. Electrocardiographic monitoring, including P wave and QT interval duration, are extremely important in obese patients. Weight control may be an effective strategy for reducing the burden of cardiac arrhythmias and sudden cardiac death.
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