Issue 5/2026
Borizanova1,2, А., Gudev1,2, A.
¹ Clinic of Cardiology, University Hospital „Tsaritsa Ioanna – ISUL“
² Department of Emergency Medicine, Medical University – Sofia
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with an increased risk of stroke, heart failure, cognitive decline, and mortality. In recent years, it has become increasingly recognized that AF often develops along a cardiometabolic continuum, in which central obesity, insulin resistance, arterial hypertension, diabetes mellitus, and chronic kidney disease (CKD) interact and promote structural and electrical remodelling of the atria. The cardiometabolic index (CMI) is emerging as a useful integrated marker for assessing visceral adiposity and metabolic risk, surpassing the limitations of body mass index (BMI). Accumulating evidence indicates that the risk of AF increases progressively with the growing burden of cardiometabolic disorders, with this effect being particularly pronounced in women. Contemporary risk assessment should include not only clinical scores and anthropometric measures, but also early markers of renal impairment, such as the urinary albumin-to-creatinine ratio (UACR) and cystatin C, as well as echocardiographic parameters of atrial remodelling. Targeted screening of high-risk patients using wearable devices, echocardiography, and periodic Holter monitoring may improve early detection and prevention of complications.
Key words: atrial fibrillation; cardiometabolic risk; cardiometabolic index; epicardial adipose tissue; atrial remodeling; screening
Adress for correspondence:
Senior Assistant Professor Angelina Borizanova
Clinic of Cardiology,
University Hospital -“Tsarina Ioanna – ISUL“
8, „Byalo More“ Str.
1527, Sofia