EDITOR'S PAGE

     AT A GLANCE

   Atrial fibrillation (AF) is the most common sustained arrhythmia in the adult population and the prevalence increases with age. People with AF have a mortality rate that is twice as high as that among people with sinus rhythm. Underlying cardiac disease, hypertension, diabetes, thyrotoxicosis, and alcohol ingestion in susceptible persons predispose to the development of atrial fibrillation. However, 17% of patients develop AF without evidence of risk factors ("lone" AF). Thromboembolism and stroke are serious complications and hence, the treatment of AF continues to be a challenge. In this issue of the Journal, Nattel from The Montreal Heart Institute Research Center, Canada, (p.152-163) gives a superb and comprehensive review of the recent evolution of our understanding of the mechanisms of atrial fibrillation and discusses scientific findings challenging the prevailing multiple-circuit re-entry mechanism. He discusses the potential implications of this new knowledge for therapeutic innovation such as catheter-based approaches. Hopefully, with increased understanding of the genesis of AF, new drugs and better techniques can be found for prevention and therapy.
   The continuing quest for improvement and refinement of existing technology as well as their innovative clinical application has enabled us to treat or ameliorate life-threatening arrhythmia with ever-increasing precision. Szili-Torok et al from the Thoraxcentre, Rotterdam, Netherlands (p.172-176), report their experience on cryothermal ablation therapy of a left-sided accessory pathway under guidance with a 3-dimensional navigational system.
   Despite the impressive strides achieved with non-surgical treatment of coronary artery disease, treatment of valvular diseases is still very much in the domain of cardiac surgeons. Mitral valve repair has proven to be superior over valve replacement in mitral regurgitation. The results of conventional surgical mitral valve reconstructions such as mitral annuloplasty with either a prosthetic ring or suture plication have been suboptimal in complex mitral valve lesions. In the early 1990s, Alfieri and colleagues introduced a simple and effective surgical technique called "edge-to-edge" mitral reconstruction for a variety of complex mitral valve lesions. Alfieri and colleagues from the San Rafael University Hospital, Milan, Italy (p.164-169), provides a comprehensive and excellent overview of their technique, indications, and clinical experience at their institution. The accompanying editorial by Kalangos of Geneva, Switzerland, addresses some of the controversial issues related to the procedure (p.170-171).
   Does the widespread perception that "honey is good for you" have a scientific basis? The History of Medicine section traces the use of honey as medicine from antiquity to the present. Illness is fundamentally different from disease.
   "Illness" refers to the innately human experience of symptoms and suffering - how the sick person and the members of his family or a wider social network perceive, live with, and respond to symptoms and disability. Illness is the "lived experience" of monitoring bodily processes such as respiratory wheezes, cramps, stuffed sinuses, etc. and the patient’s judgments about how best to cope with the distress and with the practical problems in daily living it creates. Behavior during illness consists in initiating treatment, following the advice of people and deciding when to seek care from professionals or alternative practitioners. The essay, Curing a Cold (p.178-179) is a humorous illustration of how ordinary people deal with a familiar malady – the common cold.
   Smoking is a major public health problem worldwide. Active intervention programs to increase public awareness of the dangers of smoking are needed to combat the tobacco epidemic. In his Chairman’s Reflection (p.189-193), Dr. H.A. Hajar Al Binali narrates his efforts and experience in the fight against "the evil weed" in Qatar.®

                                                                                                             Rachel Hajar, MD