Open wide: a fresh look at periodontitis and atrial fibrillation

Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting nearly 60 million people worldwide, with prevalence projected to increase by more than 60% by 2050. 1,2Optimization of traditional cardiovascular risk factors (e.g., hypertension, diabetes) that promote AF onset, recurrence, and progression are central to reducing the substantial morbidity and mortality related to AF and are a cornerstone of contemporary management. 2 However, as our understanding of AF pathophysiology deepens, so has the increasing recognition of additional "nontraditional" contributors to AF risk, including acute and chronic systemic inflammatory conditions. 3,4A more comprehensive understanding of the breadth of potential modifiable factors is critical to guide more effective AF-related prevention efforts.In this issue of the European Journal of Preventive Cardiology, Surma and Lip present a narrative review of the relationship between periodontitis-a pervasive oral inflammatory disease affecting over half the adult population globally-and AF. 5 The authors comprehensively synthesize the available literature including 97 peer-reviewed articles to aggregate contemporary evidence generally supporting the presence of associations between periodontitis and AF.First, the authors focus on pathophysiologic plausibility, detailing hypothesized mechanisms linking periodontitis and AF including chronic inflammation, autoimmunity, and direct bacterial effects on myocardial tissue.