Clinical Cardiology最新文献

We read with great interest the article titled “Clinical Characteristics and Outcomes of Catheter Ablation in Young Patients With Atrial Fibrillation” by Wang et al. [1]. We commend the authors for addressing an important and underexplored area in the management of atrial fibrillation (AF) among young patients.

AF is the most common sustained arrhythmia in adults, and its prevalence has been increasing among younger individuals in recent years. While catheter ablation (CA) has emerged as an effective treatment modality—especially in patients who are symptomatic or refractory to antiarrhythmic drugs—data specific to young populations remain limited. In this context, the study by Wang et al. [1] offers valuable insights into procedural outcomes and recurrence predictors following CA in young adults. Notably, the large sample size and comprehensive reporting of procedural characteristics strengthen the reliability and generalizability of the findings.

However, we would like to highlight some important limitations that deserve consideration. First, the average follow-up duration reported in the study was only 249 days [1]. While this duration may capture early procedural success, it falls short of assessing long-term rhythm outcomes, which are particularly relevant in a young population expected to live for decades after the intervention. Late AF recurrences represent a significant clinical issue, especially when sustained sinus rhythm is a primary therapeutic goal in younger patients.

Several studies have demonstrated that AF may recur even many years after apparently successful ablation. For example, Winkle et al. [2] reported a decline in freedom from AF from 68% at 5 years to 48% at 15 years postablation. Similarly, Steinberg et al. [3] and Erhard et al. [4] emphasized that late recurrences are common, and long-term follow-up is essential for understanding the true durability of CA. In particular, Erhard et al. showed that arrhythmia recurrence can occur even beyond the first 12 months [4], potentially due to progressive electrical remodeling or emerging triggers. Such late events may necessitate additional interventions or repeat procedures. In light of these findings, Calkins and others have underscored the importance of long-term surveillance and careful patient selection [5].

Furthermore, as young individuals often experience asymptomatic (silent) AF episodes, relying solely on symptom-driven follow-up may lead to underestimation of true recurrence rates. Incorporating prolonged rhythm monitoring techniques—such as extended Holter monitoring or implantable loop recorders—beyond the standard 3-month blanking period would likely yield a more accurate assessment of long-term procedural efficacy.

In addition, several reports have highlighted the importance of AF duration before ablation as a strong predictor of

We thank the authors for their thoughtful comments on our article “C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index as an Independent Risk Factor for Postoperative Atrial Fibrillation Recurrence” [1] and appreciate the opportunity to address their considerations.

First, Repeat ablations were performed in a subset of patients with recurrent AF, during which the status of pulmonary vein isolation was assessed. Regrettably, the sample size of these cases was insufficient to warrant a formal subgroup analysis. However, we hypothesize that a higher CALLY index may indicate inherently poorer atrial substrate properties—specifically, that an activated inflammatory state could facilitate myocardial fibrosis and the formation of reentrant circuits, thereby predisposing to AF recurrence. This hypothesis, of course, necessitates validation through further clinical and preclinical investigations.

Second, we concur that the CALLY index, which incorporates albumin levels, may reflect an activated inflammatory state that encompasses hepatic processes. Accumulating evidence suggests potential crosstalk between the liver and heart in the context of cardiovascular disease: for instance, cardiovascular conditions have been shown to exacerbate liver fibrosis in patients with fatty liver disease, with Ly6Chi monocytes playing a pivotal role [2]. It is reasonable to hypothesize that such liver-heart interactions may contribute to AF recurrence, potentially mediated by the inflammatory pathways captured by the CALLY index. As you suggested, advanced imaging modalities (e.g., cardiac magnetic resonance imaging) would undoubtedly help elucidate the intricate relationships between the CALLY index, myocardial inflammation, and AF recurrence. This constitutes a pivotal direction for our subsequent research endeavors.

Third, our baseline data revealed no significant association between alcohol consumption and AF recurrence. This is also consistent with previous study [3]. We acknowledge that larger-scale and multicenter studies are warranted to more thoroughly explore the potential role of alcohol and other lifestyle factors in AF recurrence.

Finally, we thank the authors for their insightful comments, which have improved our work's clarity and interpretative depth, thereby enhancing its clinical value in guiding AF treatment.

The authors declare no conflicts of interest.

Previous studies have reported an association between atrial fibrillation (AF) and systemic inflammation. In the present study, the authors investigated the prognostic value of the CALLY index—a composite marker reflecting both systemic inflammation and nutritional status—in predicting AF recurrence following catheter ablation [1]. They demonstrated that the CALLY index was an independent predictor of post-ablation AF recurrence. While this is an intriguing finding, several concerns merit consideration.

The authors' hypothesis is based on the assumption that systemic inflammation, as represented by the CALLY index, contributes to the development of AF [1]. However, the mechanisms underlying AF recurrence may differ from those responsible for the initial onset of AF. In particular, pulmonary vein reconnection is widely recognized as a primary cause of AF recurrence after ablation [2]. Did the authors assess the presence of pulmonary vein reconnection in patients with recurrent AF? It is possible that the CALLY index is more closely associated with non-pulmonary vein foci of AF recurrence [3].

As the CALLY index includes albumin and C-reactive protein levels, it may reflect hepatic function rather than cardiac-specific inflammation. The direct relationship between the CALLY index and cardiac pathology thus remains unclear. Advanced imaging modalities—such as cardiac magnetic resonance imaging or computed tomography—may help elucidate the relationship among the CALLY index, myocardial inflammation, and AF recurrence.

How the CALLY index could be used to guide strategies for preventing AF recurrence remains uncertain. If the index reflects impaired hepatic function, interventions such as alcohol restriction might be beneficial [4]. However, in the present study, the prevalence of alcohol consumption did not differ significantly between patients with and without AF recurrence [1].

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.