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In recent years, the presence of a low level of systemic inflammation has been shown to be a marker for the onset of atrial fibrillation (AF) and its persistence [1‐3]. Laboratory and histological findings support this association, and a relation between the level of inflammation and the arrhythmic burden was demonstrated [1‐3]. The paper by Vizzardi et al. [4 ]i nInternal and Emergency Medicine reinforces previous data showing that inflammation plays a role in predicting recurrence of AF after spontaneous or induced (pharmacologically or with electrical cardioversion) return to sinus rhythm [4‐6]. Altogether, this evidence suggests that structural (anatomical, histological and electrophysiological) changes in the atrial tissue induced by an inflammatory state may induce the onset or recurrence of AF. The paper by Vizzardi et al. [4] deals with the role of plasma high-sensitivity C reactive protein (CRP) levels in predicting recurrence of AF after successful cardioversion. Patients with structurally healthy heart, without previous rhythm control therapy, undergoing electrical cardioversion for new-onset AF were tested for plasma CRP with an ultrasensitive method. CRP levels were the only variable, which was significantly different between the group of patients who experienced a recurrence of AF and those who did not in the 6 months following the procedure. The absence of relationship between factors known to be associated with AF (i.e. hypertension, left atrial dimensions, duration of AF) and its recurrence after cardioversion in this study is probably due to the type of patients enrolled: all had AF of recent onset, in absence of structural heart disease; patients with severe left atrial dilation, reduced left ventricle ejection fraction, kidney failure or pro-inflammatory conditions were excluded. It is probably in the type of population enrolled that latent systemic inflammation plays a significant role in the pathogenesis of AF, as it does in patients with postoperative AF.

Mild inflammation may switch on again atrial fibrillation after successful electrical cardioversion