Coronary atherosclerosis and quantitative myocardial perfusion: a relationship beyond stenosis.

I read with interest the editorial comment by Asirvatham and Gard (1). The authors note that atrial fibrillation is more common in athletes and long distance runners. They then posit a complex theory (fulcrum for cardiac translatory movement) to explain the tissue damage that occurs at the level of the inferior pulmonary veins, as evidenced by the findings of fibrosis and fibrofatty changes reported by Platonov et al. (2). I suggest a less complex alternative hypothesis. Recalling the zones of West (3), perhaps tissue damage occurs at the level of the inferior pulmonary veins, particularly in long distance runners, because of the increased flow that these vessels support relative to their superior counterparts.