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To the Editor: Dr Wang and colleagues¹ conclude that obesity is an important risk factor for AF and that this excess risk appears to be mediated by left atrial enlargement. We are concerned about 3 potential limitations of this study.

First, AF was diagnosed by electrocardiograms obtained either from hospital or physician charts or from routine Framingham clinical examinations. However, obese participants were approximately 2 to 3 times more likely to be receiving antihypertensive medications and approximately 2 to 5 times more likely to have diabetes than were normal-weight participants. As a result, obese participants are likely to have had more hospital and physician visits—and hence more chances of having their AF diagnosed. This is especially relevant to new-onset AF, in which spontaneous conversion to sinus rhythm occurs in almost two thirds of patients^2-3 and in which up to 90% of episodes are not even recognized by the patients.⁴ The . . . [Full Text of this Article]

Harpreet S. Bajaj, MD
hb8188@albany.edu

Steven D. Hillson, MD, MSc
Department of Internal Medicine
Hennepin County Medical Center
Minneapolis, Minn

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