Letter to Editor.

Dear Editor,

The article written by Sharma et al. on “High sensitive C-reactive protein and interleukin 6 in atrial fibrillation with rheumatic mitral stenosis from Indian cohort” is very interesting. Sharma et al. found that, “Increased hs-CRP and IL-6 levels in the paroxysmal and permanent AF group may favour the hypothesis that low grade chronic inflammation could be the cause of atrial fibrillation than a consequence.”

In the methodology part, chornic autoimmune and/or rhematic disease was not excluded. Glucocorticoids remain at the fist lineanti-inflammatory and immunosuppressive treatment for both acute and chronic inflammations, including rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, psoriasis and eczema, as well as being used in leukaemias and in following organ transplant. Taking immunosupressive medications (ex. corticosteroids and/or IVIG) can affect and change plasma acute phase reactant levels and interleukin levels, can inhibit the activity of crucial transcriptional regulators of pro-inflammatory genes, including NF-κB and AP-1, so patients who taking these drugs should have been excluded from the study. Another missing point is about echocardiographic measurements of left atrial size. Especially in a prospective study, measurement of heart chamber size should be evaluated with 3D echocardiography for obtaining better data. Compared with cardiam magnetic resonans reference, 3D echocardiographic evaluation of left atrial measurement are more accurate than 2D echocardiographic based analysis.

Conflict of interest

None.