Periodontitis and atrial fibrillation

Periodontitis is one of the most common inflammatory diseases worldwide, affecting over half of the population. It is a focus of chronic low-grade systemic inflammation, which is thought to contribute to the pathogenesis of cardiovascular diseases, including atrial fibrillation (AF), the most common supraventricular arrhythmia. A review of available epidemiological and pathophysiological studies, despite existing methodological limitations, indicates that individuals with moderate to severe periodontitis have a significantly higher risk of developing AF, and in patients already suffering from AF, the presence of periodontitis is associated with a poorer prognosis: a higher risk of recurrent arrhythmia, stroke, and cardiovascular events. Multiple mechanisms linking both diseases have been identified, including chronic immune activation, proinflammatory cytokines (CRP, IL-6, TNF-α), autoimmunity, atrial fibrosis, and the direct effects of oral pathogens (e.g., Porphyromonas gingivalis) on myocardial tissue. Furthermore, these diseases share many risk factors: obesity, diabetes, smoking, and low socioeconomic status. Scientific evidence indicates that periodontal treatment (scaling, periodontal therapy, improved oral hygiene) significantly reduces inflammatory markers and the risk of AF. The authors propose that oral health be considered as part of integrated care for patients with AF (ABC pathway). Despite the growing body of evidence, current cardiology guidelines do not address the role of periodontitis, indicating the need for updated standards of care. This narrative review summarizes the current knowledge regarding the relationship between periodontitis and AF.