Author + information
- M. Obadah Al Chekakie, MD and
- Joseph G. Akar, MD, PhD⁎ ()
- ↵⁎Section of Cardiovascular Medicine, Yale University School of Medicine, Cedar Street, FMP 3, New Haven, Connecticut 06511
We thank Drs. Liu and Li for their remarks and interest in our work (1). The spatial distribution of adipose tissue around the heart is variable, with patches of fat adjacent to myocardium. Furthermore, significant heterogeneity of fat distribution exists among individuals, which makes it difficult to use a single regional measurement as a representative surrogate of actual overall volume or distribution. Total pericardial fat volume has been shown to be a risk factor for atrial fibrillation (AF) in our study as well as in others (1,2). A recent article on the Framingham study showed that pericardial fat was associated with prevalent AF even after correction for other risk factors (2). That study, as well as ours, did not compartmentalize the fat areas, and instead reported the entire pericardial fat volume, which is the most widely accepted method of measurement. We agree with Drs. Liu and Li that the distinction between atrial and ventricular pericardial fat is of interest and that the optimal method of measurement of adipose tissue in these specific compartments needs to be defined. Importantly, the mechanisms by which pericardial fat predisposes to AF need to be elucidated. It is reasonable to hypothesize an inflammatory mechanism based on the paracrine properties of visceral adipose tissue (3). As such, the exact regional distribution of fat may not be relevant, because there are no barriers in the pericardium separating the atria from the ventricles and thereby precluding local effects. We agree with Drs. Liu and Li that this relationship may represent an important therapeutic target for AF, and we look forward to future studies that shed light on the pathophysiological mechanisms.
- American College of Cardiology Foundation
- Al Chekakie M.O.,
- Welles C.C.,
- Metoyer R.,
- et al.
- ↵Thanassoulis G, Massaro JM, O'Donnell CJ, et al. Pericardial fat is associated with prevalent atrial fibrillation: the Framingham Heart Study. Circ Arrhythm Electrophysiol;3:345–50.
- Mazurek T.,
- Zhang L.,
- Zalewski A.,
- et al.