《国际循环》：ACC 2013年会上有6个关于药理学专题会，作为专题会的联合主席，您能谈谈房颤抗心律失常药物使用吗？

　　Prof. Alpert: There were actually two sessions related to atrial fibrillation. One was directly related to the issue of restoring normal sinus rhythm either by drugs or ablation， the electrical physiology intervention， and then there was the session on the new anticoagulants which are specifically that dealt with stroke prevention in patients with atrial fibrillation so there were actually two sessions on atrial fibrillation. So there were actually two sessions dealing with atrial fibrillation. The first one looked at which patients should you leave with atrial fibrillation and just control the heart rate and which patients are candidates for a more aggressive treatment either with drugs or with the electric physiology ablation procedure to try and keep people with the normal sinus rhythm. Basically the answer that came out is one that is also in the guidelines and I’m a person who is on the right and for the new guidelines that will be coming out in the next few months from the American Heart Association and the American College of Cardiology Foundation. The message is clearly a negotiated settlement. It is dependent on the patient. Let me give you two examples. If you have a patient who is elderly and not very active and is comfortable with atrial fibrillation then clearly that is a candidate for controlling the heart rate and， of course， the anticoagulants for embolic stroke. On the other hand， if you have a younger patient who is more active and particularly if he or she feels uncomfortable， for example， shortness of breath， fatigue， and etc. with atrial fibrillation， that would be a patient you would work on very hard， first with drugs and then the electrical physiology to keep normal sinus rhythm.

　　Alpert教授：有两个专题会和房颤相关。一个是关于通过药物或消融的电生理干预方法恢复正常窦性心律。另一个是关于新型抗凝药预防房颤患者卒中发生。第一个专题着眼于哪些患者只需控制心率，哪些需要用药物或射频消融强化治疗维持窦性心律，答案也会在临床指南中给出，我是指南的制订者之一，指南会在几个月内由AHA和ACCF联合公布。治疗策略是协商解决，取决于患者情况。举两个例子，如果患者年龄大，活动少，并且没有明显房颤症状，很显然这个患者适合控制心率，当然还要抗凝治疗预防卒中。而如果是较年轻患者，活动多，特别是如果有房颤症状，如气短、疲劳等，就应当强化治疗，首先用药物，如果药物无法转复心律则需电生理手术维持正常心律。

　　<International Circulation>: Do you see any developments in the next couple years in the treatment of the antiarrythmic part?

　　《国际循环》：您对抗心律失常治疗未来几年发展有什么展望？

　　Prof. Alpert: Yes. There’s this new drug that’s been out for a couple of years called dronedaron. It’s a variant of amiodatone but much shorter acting and fewer side effects. Unfortunately it’s not quite as effective as amiodarone. So amiodarone is still the most effective drug but also the one with the most side effects. Other than that there aren’t any other new drugs that are on the horizon but what is getting better and better is the ablation procedure. The ability to get people and keep them in normal sinus rhythm is about seventy percent and often with then some drugs the success rate is within eighty percent. Often times patients then need a second or third procedure but eventually most of them do very well.

　　Alpert教授：有1种新药已经问世数年，叫决奈达隆，和胺碘酮属同类药，但起效快很多，且不良反应较少。不幸的是，并不如胺碘酮有效。因此，胺碘酮仍是最有效药物，同时也是不良反应最多的药物。除这个药物外，目前并没有任何即将问世的新药。但我们在消融术方面取得越来越好的结果。能够转复并维持正常窦性心律比例约70%，联合药物治疗成功率可达80%。患者常需第2次或第3次手术，但最终绝大多数都能取得良好结果。

　　<International Circulation>: And would you recommend ablation for both young and old patients?

　　《国际循环》：您会推荐年轻和老年患者都接受消融术吗？

　　Prof. Alpert: Well， yes. Suppose you have a patient who is an athlete. Some athletes will have paroxysmal or persistent atrial fibrillation and clearly that’s not good for a competitive athlete and so they will go very quickly to the ablation procedure. On the other hand， for a middle-aged patient whose doesn’t need to be a competitive athlete， that patient can usually be managed with drugs first and if they fail with drugs then can turn to ablation.

　　Alpert教授：是的。假设患者是运动员，有些运动员有阵发性或持续性房颤，对他来说是不利的，因此，他们会很快接受消融术。另一方面，对于中年患者来说，他并不需成为运动员，通常可以先使用药物治疗，如果药物治疗失败则进行消融。