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Implication to predict postoperative atrial fibrillation following pulmonary thromboendarterectomy

To the Editor, Liu and colleagues demonstrated that the development of postoperative atrial fibrillation (POAF) was not rare after pulmonary thromboendarterectomy (PTE), and the resting heart rate and age were their preoperative predictors. Several concerns have been raised. The implication to predict POAF before PTE might be unclear. Anticoagulation therapy is generally continued following PTE irrespective of the existence of POAF. The risk of stroke might not be affected by the occurrence of POAF. The loss of atrial kick has a negative impact on heart failure patients. Does POAF have any negative impacts beyond the risk of stroke following PTE? Furthermore, we can consider catheter ablation to treat POAF if necessary. For those with a higher resting heart rate at baseline, what can we do? Ivabradine might be promising by reducing heart rate if a higher heart rate itself is harmful. Beta‐blocker might also be helpful to stabilize inappropriately activated sympathetic nerve activity. In their study, some patients had a previous history of atrial arrhythmia, including atrial fibrillation and atrial flutter. Frequent premature atrial complex is a well‐known risk factor for persistent atrial fibrillation. Did the authors consider such a type of arrhythmia to include baseline characteristics? Detailed surgical data is unclear. Cardiopulmonary bypass time and cross‐clamp time might also have a negative impact on the occurrence of POAF following PTE. CONFLICTS OF INTEREST The authors declare no conflicts of interest.