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To the Editor: The study by Dr Wang and colleagues¹ provided evidence for an association between obesity and development of atrial fibrillation (AF). The authors proposed several underlying mechanisms but did not mention the potential role of inflammation in this setting. Accumulating evidence suggests that inflammation may have a significant impact on atrial remodeling, which favors perpetuation of AF.² Even though it is not yet clear whether inflammation represents a cause or a consequence of AF, it has been recently demonstrated that elevated inflammatory indexes such as C-reactive protein indicate an increased risk for future development of AF.^2-3 On the other hand, obesity has been clearly correlated with inflammation,⁴ whereas weight loss significantly reduces the levels of inflammatory indexes.⁵ It is therefore reasonable to assume that obesity-associated inflammation might contribute to the atrial remodeling. Whether this mechanism has a clinical impact on AF remains to be elucidated.

Panagiotis Korantzopoulos, MD
pkor@oneway.gr
Department of Cardiology
"G. Hatzikosta" General Hospital
Ioannina, Greece

Theofilos M. Kolettis, MD, PhD
Department of Internal Medicine
University of Ioannina Medical School
Ioannina

1. Wang TJ, Parise H, Levy D, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292:2471-2477. FREE FULL TEXT 2. Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Med Sci Monit. 2003;9:RA225-RA229. PUBMED 3. Anderson JL, Allen Maycock CA, Lappe DL, et al. Frequency of elevation of C-reactive protein in atrial fibrillation. Am J Cardiol. 2004;94:1255-1259. FULL TEXT | WEB OF SCIENCE | PUBMED 4. Saito M, Ishimitsu T, Minami J, Ono H, Ohrui M, Matsuoka H. Relations of plasma high-sensitivity C-reactive protein to traditional cardiovascular risk factors. Atherosclerosis. 2003;167:73-79. FULL TEXT | WEB OF SCIENCE | PUBMED 5. Esposito K, Pontillo A, Di Palo C, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003;289:1799-1804. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293:1974.

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