Editorial: Pharmacological therapy in patients with arrhythmias

For these reasons, early detection of AF represents an important goal; for this purpose, different tools of ECG monitoring (prolonged Holter ECG records, external loop recorder, event recorder, implantable devices) can be useful (11,12).In addition, maintenance of sinus rhythm can lead to better clinical outcomes, in patients suffering from AF: quality of life improves in symptomatic patients and cardiac mortality appears reduced in the setting of heart failure (13). To achieve this objective, the most powerful weapon available seems to be catheter ablation. However, despite the different kind of energy usable and the enormous amount of techniques developed to treat this arrhythmia, ablation procedure appears far from to be considered a definitive solution (14)(15)(16)(17)(18), even if a tailored approach can allow increasing efficacy, minimizing procedural risks (19,20).Additional pharmacological therapy, to maintain sinus rhythm after cardiac ablation, can be a helpful tool as suggested by Fei and colleagues in this special issue: they presented a retrospective observational study that encompassed 420 elderly patients with AF following ablation procedure. Predictors of early recurrences were identified in left atrial size, left ventricular dimensions and some humoral biomarkers; in this setting, compared to amiodarone, propafenone and sotalol exhibited an elevated risk of early recurrence.Prevention of ischaemic stroke is another crucial point in patients affected by AF. This topic is extensively covered in this special issue: Yin and colleagues have drawn up a vademecum of 17 recommendations on the use of fondaparinux in numerous settings, including that concerning the treatment of patients after a cardioversion for atrial fibrillation. An important part of this special issue is dedicated to direct-acting oral anticoagulants (DOACs), suggesting, in some cases, particular usage: Pan and colleagues, for example, explored the feasibility and safety of twice daily rivaroxaban as a postoperative anticoagulation regimen for patients with AF undergoing left atrial appendage closure (LAAC). They found that a short course of twicedaily rivaroxaban following LAAC is a feasible alternative regimen with a low rate of major bleeding events, and device-related thrombosis (DRT), thromboembolic events for patients with AF.Furthermore, usage of DOACs, could open new scenarios for the management of anticoagulation in sports players affected by AF. Minardi and collegues for example, suggested that the pharmacological profile of DOACs could offer theoretical solutions for overcoming the increased risk of bleeding in sports patients: drugs with lower half-lives could allow sports at risk of trauma within the "therapeutic window," when the estimated blood concentration of the drug is minimal.Finally, present special issue underline the importance of a rigorous management of anticoagulation therapy to reduce the incidence of haemorrhagic events in AF patients: Zhang and colleagues showed the beneficial effects of a national centralized drug procurement policy on anticoagulation selection in terms of medical adherence and reduction of adverse events.