We have read with interest the article 'Lower preoperative fluctuation of heart rate variability is an independent risk factor for postoperative atrial fibrillation in patients undergoing major pulmonary resection' by Pawel Ciszewski and coworkers [1]. In that very well-designed study Ciszewski et al. concluded that preoperative lower fluctuation of heart rate variability (HRV) is an independent atrial fibrillation (AF) riskŦactor in the postoperative period in patients undergoing major pulmonary resection.
Atrial fibrillation is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority [2]. Chronic kidney disease (CKD) has been strongly associated with new-onset AF [3]. For this reason, kidney function is important in predicting mortality and morbidity in patients with AF. Serum creatinine level is the most common test for renal failure. On the other hand, elevated transaminase concentrations are related to increased risk of AF [4]. Furthermore, in the previous large population-based study, higher serum phosphorus and the related calcium-phosphorus product were also associated with a greater incidence of systemic embolism in patients with AF. Additionally, some medications may cause new-onset AF. The authors previously examined whether or not exposure to non-steroidal anti-inflammatory drugs (NSAIDs) was a risk factor for AF. They concluded that recent NSAID use may predispose patients to AF [3]. Bisphosphonate use was also associated with a significant increase in the risk of serious AF in postmenopausal women [5].
In conclusion, the link between AF and thoracic surgery was presented in the current study. However, AF may be affected by many conditions and it would have been better if these factors had been included in the paper. Finally, we believe that the pivotal roles of those risk factors deserve further large-scale prospective randomized clinical trials.
Conflict of interest: none declared
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