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Chocolate and prevention of atrial fibrillation: what is bad for the pancreas might be good for the atria?
  1. Sean D Pokorney,
  2. Jonathan P Piccini
  1. Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, USA
  1. Correspondence to Dr Jonathan P Piccini, Duke Center for Atrial Fibrillation, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA; jonathan.piccini{at}

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Atrial fibrillation (AF) is the most common arrhythmia, affecting over 33 million patients worldwide, and 25% of adults will develop AF over their lifetime.1 Patients with AF have higher rates of heart failure, hospitalisation, stroke and cognitive impairment as well as lower quality of life; these factors result in large direct and indirect costs to the healthcare system and society.1 The mechanisms of AF are multifactorial and not well understood, although genetic and cardiovascular risk factors are associated with AF.2–4 Because there is no cure for AF and patients are forced to manage AF as a chronic disease, prevention of AF is the optimal approach, although most AF-related studies focus on treatment instead of prevention.4

Unfortunately, there are no effective, proven therapies for the primary prevention of AF. Nearly 60% of AF can be attributed to modifiable risk factors. For example, hypertension accounts for 20% of the risk of AF.4 Lifestyle modification like weight loss and smoking cessation may contribute to AF prevention. Weight loss has been associated with lower AF burden and improved maintenance of sinus rhythm.3 Management of cardiovascular risk factors would also likely result in AF prevention. Better controlled hypertension, diabetes and cholesterol have been shown to improve arrhythmia-free survival after AF ablation,4 whereas coronary artery disease contributes to AF through myocardial fibrosis, atrial dilation, inflammation and ischaemia.1 4 Sleep apnoea is another modifiable factor that has been strongly associated with AF, although no randomised trials have demonstrated that treatment of sleep apnoea prevents AF.2–4 Ultimately, there are multiple potential approaches for the prevention of AF, which have been identified …

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  • Competing interests SDP reports modest consulting support from Boston Scientific and Medtronic; modest research support from Gilead, Boston Scientific, Bristol-Myers Squibb, Pfizer and Janssen Pharmaceuticals. JPP reports grants for clinical research from ARCA biopharma, Boston Scientific, Gilead, St Jude Medical and Spectranetics, and serves as a consultant to Allergan, Amgen, GSK, Medtronic and Spectranetics.

  • Provenance and peer review Commissioned; internally peer reviewed.

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