In our study (1) we observed a reduced incidence of atrial fibrillation (AF) following coronary artery bypass surgery in patients receiving polyunsaturated fatty acids (PUFAs). The way these compounds could have determined this result is, at present, only speculative. Indeed, PUFAs have been demonstrated to have a direct anti-arrhythmic effect in different laboratory models, but the importance of a concurrent (or prevalent) anti-inflammatory action cannot be excluded. In fact, PUFAs have anti-inflammatory properties (2), and inflammation, as correctly pointed out by Dr. Korantzopoulos and colleagues can play a fundamental role in postcardiac surgery AF. Actually, the efficacy of an anti-inflammatory therapy in this setting is still not clear owing to conflicting reports. Whereas a single postinduction steroid administration was shown to prevent postoperative AF (3), a similar protocol was found ineffective in other hands (4). The debate on this subject is thus still open, but unfortunately a further contribution cannot be obtained by our study, because C-reactive protein (CRP) levels or other inflammatory indexes were not routinely collected in our patients.

Concerning off-pump surgery that could carry a lower risk of AF due to a lesser oxidative and inflammatory response, aside from reports supporting this assumption (5) there are other studies that do not confirm this finding (6). In our study the incidence of AF was similar in patients receiving off-pump surgery (26.3% of 19 cases) and those submitted to on-pump surgery (24.1% of 141 cases). However, our population is too scarce to draw any conclusion on this subject.

Statins have been reported to prevent AF both after cardiac surgery (7) and after electrical cardioversion (8), possibly by their pleiotropic anti-inflammatory action. In our examination we did not observe any difference in AF incidence between patients on statins (24.2% of 91 patients) and those not on statins (24.6% of 61 patients). This could be due to the fact that the mean dose of statins in our patients was low (15.3 ± 9.2 mg/day simvastatin and 13.2 ± 7.5 mg/day atorvastatin) and the anti-inflammatory and thus, possibly, anti-arrhythmic effect of statins seems to be related to the dose. In fact, a recent study reported a significant decrease of CPR (−36.4%) with atorvastatin 80 mg but not with pravastatin 40 mg (−5.2%) (9).