Strengths and limitations
This study has several strengths. First, this is the first clinical study to investigate the expression of BRD4 in patients with non-valvular and non-ischemic cardiomyopathy AF, as well as to investigate the relationship between BRD4 and AF recurrence after ablation. Second, this is the first study to investigate the role of BRD4 in atrial fibrosis and AF via the TGF-β/Smads signaling pathway. Third, this study is the first to describe the relationship between BRD4 and LAAPD, LVEF, and LVAs.
This study also has several limitations. First, the number of study cases was relatively small, and a large sample of data was needed for observation and analysis. Second, more accurate indicators of left atrial size, such as left atrial volume index, are needed for further validation. Third, the level of BRD4 in peripheral venous blood does not fully represent the level of BRD4 in left atrial tissue, and it is necessary to collect left atrial blood samples and left atrial tissue of patients with AF for further verification (e.g., through myocardial biopsy technology). Fourth, the animal experimental methodology was relatively simple, and the mechanism study was not sufficiently in-depth. BRD4 gene knockout and transfection technology should be employed in the future to enhance BRD4 expression and verify the results of this study from multiple perspectives. Fifth, we did not use enough indicators to reflect atrial fibrosis, and more indicators are needed for further verification (such as ST2 and galectin 3). Sixth, further studies are needed to verify whether BRD4 inhibition could attenuate the degree of LAVs in patients with AF and reduce the postoperative recurrence rate of AF.