Subepicardial adipose tissue as a modulator of arrhythmias.

The subepicardial tissue is composed of myocardium, fatty tissue, neurons, inflammatory cells, arteries, veins and lymphatic vessels. These components are intimately related and not separated by a visceral layer. Myocardial function can be altered by invasion of adipose tissue into the myocardium creating structural changes, by electrotonic coupling between myocytes and adipocytes, and in response to epicardial adipose secretome signalling. Paracrine signalling from epicardial adipose tissue to the adjacent myocardium is likely mediated by extracellular vesicles through its cargo of miRNAs, proteins and lipids. Weight loss is the mainstay of the prevention of arrhythmias induced by epicardial adipose tissue. Regression of epicardial adipose tissue in the context of weight loss has been associated with favourable electrophysiological reverse remodeling. Local anti-arrhythmic therapies designed to inhibit constituents of the epicardial adipose secretome or to desensitize the target myocardium remain future therapeutic options.

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