The relationship between cardiac calcification and cardiovascular events is well-established, although the clinical impact of valvular calcification on arrhythmia incidence remains unclear. In their study, Liu et al. demonstrated that valvular calcification independently increased the risk of recurrent persistent atrial fibrillation following radiofrequency catheter ablation.¹ However, several points warrant further exploration.

While the correlation between mitral valve calcification and left atrial remodeling, elevated left atrial pressure, and atrial fibrillation development seems plausible, it remains uncertain why other forms of valvular calcification were similarly linked to atrial fibrillation recurrence. Additionally, the authors could shed light on why calcification of the pulmonary valve did not exhibit an association with recurrent atrial fibrillation.¹

The exclusion of individuals with rheumatic heart disease raises methodological questions.¹ Further elaboration on the methodology for their exclusion would be beneficial, particularly considering the challenges in distinguishing rheumatic valvular disease from other forms of valvular pathologies. Notably, rheumatic fever can give rise not only to mitral stenosis but also to mitral regurgitation.²

In the study, the authors dichotomized the presence of valvular calcification.¹ While acknowledging that computed tomography stands as the gold standard for quantifying cardiac calcification,³ it would be advantageous if the authors quantified the degree of valvular calcification, treating them as continuous variables. Otherwise, assuming approximately 90% of the participants had no valvular calcification could raise concerns regarding the accuracy of their conclusions.¹

Addressing the practical implications of their findings is pivotal.¹ It would be valuable for the authors to propose potential therapeutic or prophylactic strategies for individuals with valvular calcification. For instance, should additional linear ablations be considered alongside conventional pulmonary vein isolation?

尽管瓣膜钙化对心律失常发生率的临床影响仍不清楚，但心脏钙化与心血管事件之间的关系已明确。在他们的研究中，刘等人。证明瓣膜钙化独立增加射频导管消融后复发持续性心房颤动的风险。¹然而，有几点值得进一步探讨。

虽然二尖瓣钙化与左心房重塑、左心房压力升高和心房颤动发展之间的相关性似乎合理，但仍不确定为什么其他形式的瓣膜钙化与心房颤动复发也有类似的相关性。此外，作者还可以阐明为什么肺动脉瓣钙化与复发性心房颤动没有关联。¹

将风湿性心脏病患者排除在外引发了方法学问题。¹进一步阐述排除这些疾病的方法将是有益的，特别是考虑到区分风湿性瓣膜病与其他形式的瓣膜病理学的挑战。值得注意的是，风湿热不仅会引起二尖瓣狭窄，还会引起二尖瓣关闭不全。²

在这项研究中，作者将瓣膜钙化的存在分为两类。¹虽然承认计算机断层扫描是量化心脏钙化的黄金标准，但³如果作者量化瓣膜钙化程度，并将其视为连续变量，那将是有利的。否则，假设大约 90% 的参与者没有瓣膜钙化可能会引起对其结论准确性的担忧。¹

解决他们的发现的实际影响至关重要。¹对于作者来说，为瓣膜钙化患者提出潜在的治疗或预防策略是很有价值的。例如，在传统肺静脉隔离的同时是否应该考虑额外的线性消融？