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Authors have addressed all of the reviewers' comments and the manuscript is ready for publication.
[# PeerJ Staff Note - this decision was reviewed and approved by Celine Gallagher, a PeerJ Section Editor covering this Section #]
**PeerJ Staff Note:** Although the Academic and Section Editors are happy to accept your article as being scientifically sound, a final check of the manuscript shows that it would benefit from further English editing. Therefore, please identify necessary edits and address these while in proof stage.
The manuscript has been improved. Further professional editing is recommended. The rationale for selecting miR-15a-5p is clearer but could still be more focused. References are largely appropriate.
The design is acceptable but limited by a small sample size and retrospective, single-center nature.
The findings are suggestive but not definitive.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
This report is well written and presents the validity of serological tests predicting the recurrence of A fib after ablation, which can avoid expensive and time-consuming LGE MRI to assess recurrence. It contributes to the existing literature by highlighting the role of miRNA in AFib recurrence.
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Please address if there are any other potential causes for recurrent A-fib.
The remodeled left atrium is more prone to develop recurrent A fib, it would be more valuable to address the issues raised in the manuscript, such as BMI, any valvular heart disease, LA size, A fib duration, and any inflammatory conditions.
1. The manuscript requires substantial language editing. Several sections contain awkward phrasing, redundancy, and inconsistent terminology (e.g., "expression level" vs "concentration"). The English should be revised for clarity and precision.
2. The introduction lacks a focused rationale for selecting miR-15a-5p. Prior evidence linking miR-15a-5p to atrial fibrosis or recurrence is briefly mentioned but not systematically discussed. Key studies should be better integrated to establish a clear knowledge gap.
1. The sample size is small, particularly in the recurrent subgroup (n=7), limiting the robustness of regression and ROC analyses. Power calculations are not provided.
2. The study design is retrospective and single-center, but these limitations are not addressed. Selection bias and confounding factors are likely present.
3. Methods for exosome isolation, RNA extraction, and qRT-PCR are described, but with insufficient technical details for replication. For instance, reagent catalog numbers and control quality metrics (e.g., RNA integrity) are missing.
4. The definition of recurrence is standard, but post-ablation management protocols (e.g., antiarrhythmic drug use) should be described more clearly, as they may affect outcomes.
1. Logistic regression is applied with a limited number of events, increasing the risk of model overfitting. The model diagnostics and variable selection procedures are not reported.
2. ROC curve analysis is based on a small sample and may produce unstable estimates. No cross-validation or independent validation is conducted.
3. Correlations between miR-15a-5p and fibrosis markers are reported without correction for multiple comparisons.
4. The conclusions imply predictive utility of miR-15a-5p, but this is not supported by prospective or external validation. Mechanistic claims regarding fibrosis are not experimentally verified and should be toned down.
1. The limitations of the study are not adequately discussed. The authors should clearly acknowledge the retrospective design, small sample size, lack of validation, and potential confounding.
2. The statistical analysis section should specify software versions, test assumptions, and handling of missing data.
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