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The Obesity-OSA-Arrhythmia Axis: Pathophysiological Mechanisms and Translational Therapeutic Targets
Fulvio Cacciapuoti1, Ilaria Caso2, Antonietta Buonomo3
1Division of Cardiology, "Antonio Cardarelli" Hospital, 80131 Naples, Italy.
Life (Basel, Switzerland)
|May 27, 2026
Summary
Obesity and obstructive sleep apnea (OSA) increase cardiovascular risk by affecting heart electrical stability. Integrated therapies targeting metabolic and autonomic pathways offer new strategies for managing arrhythmias.
Area of Science:
- Cardiology
- Sleep Medicine
- Metabolic Disorders
Background:
- Obesity and obstructive sleep apnea (OSA) synergistically promote cardiovascular disease.
- This interaction involves mechanical, metabolic, and autonomic pathways, leading to myocardial electrical instability and arrhythmias like atrial fibrillation.
- Epicardial adipose tissue and OSA-related hypoxia/pressure swings are key mediators of cardiac arrhythmogenesis.
Purpose of the Study:
- To explore the interconnected mechanisms linking obesity and OSA to cardiac arrhythmias.
- To review emerging therapeutic strategies targeting these underlying pathophysiological processes.
- To advocate for an integrated, phenotype-driven approach to managing cardiovascular risk in this patient population.
Main Methods:
- Review of existing literature on the interplay between obesity, OSA, and cardiac arrhythmias.
- Analysis of the roles of epicardial adipose tissue, intermittent hypoxia, and autonomic imbalance.
- Evaluation of current and emerging therapeutic interventions, including metabolic therapies (e.g., tirzepatide) and electrophysiological procedures (e.g., cardioneuroablation).
Main Results:
- Obesity and OSA create a pro-arrhythmic substrate through inflammation, fibrosis, autonomic dysfunction, and direct mechanical effects.
- Metabolic therapies like tirzepatide show promise in reducing weight and OSA severity, potentially mitigating arrhythmic risk.
- Cardioneuroablation is an investigational option for specific bradyarrhythmias.
Conclusions:
- An integrated therapeutic approach combining respiratory support, metabolic modulation, and targeted electrophysiological interventions is crucial.
- Shifting focus from symptom control to modifying the arrhythmogenic substrate can improve long-term cardiovascular outcomes.
- Phenotype-driven strategies are essential for optimizing treatment in patients with obesity and OSA-related cardiovascular complications.
Keywords:
atrial fibrillationautonomic dysfunctioncardiac arrhythmiascardioneuroablationepicardial adipose tissueobesityobstructive sleep apneatirzepatideMore Related Videos
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