Letter by Kosiuk et al Regarding Article, “Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control])”
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To the Editor:
We read with great interest and anticipation the final publication of the late-breaking trial by Parkash et al.1 The authors should be complimented for looking beyond the horizon of ablation and searching for further supportive measures to improve rhythm outcome.
The SMAC-AF trial (Substrate Modification With Aggressive Blood Pressure Control) studied the effects of aggressive blood pressure (BP) treatment on the outcome of atrial fibrillation (AF) ablation. Although systolic BP was significantly lower in the aggressive treatment group (123.2 mm Hg versus 135.4 mm Hg, P<0.001), no difference in the primary outcome was observed.
AF is a progressive disease partly because of underlying progressive atrial remodeling. This formation of proarrhythmic substrate is …