Letter from the Editor in Chief

DOI: 10.19102/icrm.2016.070406

MOUSSA MANSOUR, MD, FHRS, FACC

Editor-in-Chief

Dear Readers,

Many cardiac arrhythmias, such as atrial fibrillation, have definite precipitating factors. Identification and modification of these factors can improve and even prevent the arrhythmias. The cardiac electrophysiology scientific community has been very active in discovering cutting edge treatments for various rhythm disorders. However until recently, research aimed at identification of precipitating factors and designing prevention plans has been lagging.

The article by Shah et al. published in this issue of the Journal represents one example of a trend that we have been witnessing over the recent few years. The authors studied the effect of energy beverages containing caffeine and taurine on the cardiovascular system. They found that energy drinks can result in increase of blood pressure and prolongation of QT interval. Despite some limitations including the small number of patients, the study is important because it highlights the emerging interest in discovering precipitating factors for different arrhythmias.

This evolving trend is most clear in the field of atrial fibrillation. Recently, there has been growing evidence to underscore the importance of obesity, obstructive sleep apnea, and alcohol abuse as risk factors for the initiation and progression of AF. The establishment of these epidemiological links subsequently triggered studies to investigate the physiology of the effects of the precipitating factors. Animal models of obesity and sleep apnea have been developed and helped clarify how these precipitating factors can result in atrial fibrosis, inflammation, and eventually alterations in inter-cellular electrical communications that lead to atrial fibrillation.

All these efforts have been critical in furthering our understanding of atrial fibrillation. However identifying precipitating factors will not by itself make an impact on a global epidemic such as atrial fibrillation. The recent discoveries of the types of risk factors and how they work, needs to be coupled with prevention plans aiming at reducing obesity and diagnosing sleep apnea.

At Massachusetts General Hospital, a program targeting risk factors in patients with atrial fibrillation has been initiated. Patients with a body index of 28 or more presenting for catheter ablation, are offered referrals for sleep apnea testing and weight loss education and treatment. We believe that such an integrated multidisciplinary approach will maximize the value of advanced and expensive treatments such as ablation.

I hope that you enjoy reading this issue of the Journal.

Regards,

Editor-in-Chief

Moussa Mansour, MD, FHRS, FACC
Editor-in-Chief
The Journal of Innovations in Cardiac Rhythm Management
MMansour@InnovationsInCRM.com
Director, Cardiac Electrophysiology Laboratory
Director, Atrial Fibrillation Program
Massachusetts General Hospital Boston, MA