International Circulation: Now about atrial fibrillation， it is the most common arrhythmia， it is often associated with some sort of catastrophic or very expensive endpoint including heart failure. Maybe you could talk a little bit about the special considerations or differences between the management of atrial fibrillation in an ordinary patient or someone that is in a heart failure situation?

 

　　《国际循环》：心房颤动是最常见的心律失常，常可导致包括心力衰竭在内的很多灾难性或治疗成本非常高的严重终点。能否请您谈一下，与普通心房颤动患者相比，合并心力衰竭的心房颤动患者的管理有哪些特殊注意事项和差异？

 

　　Dr. Shen : Yes I just mentioned atrial fibrillation and heart failure are really the two of the three epidemic cardiovascular conditions in the States.  When it comes to atrial fibrillation， I have always taken the position， I have spoken about this， and I have written about this， is that atrial fibrillation is not a single condition， it is really the result of many medical conditions and coming to a clinical manifestation of abnormal rhythm.  It is critically important to tackle and aggressively treat the underlying disease and the associated conditions at the same time treating that atrial fibrillation. In patients without other significant heart conditions， treating atrial fibrillation takes many different strategies and most times because the patients are healthier and usually they are stronger and younger， so they have more options， whether they are using medical therapy for treating these patients or interventional therapy such as ablation.  We have made significant advances in the last 10 to 15 years for the interventional therapy for atrial fibrillation.  We still have a long ways to go. In patients with heart disease like this morning we presented the review on patients with atrial fibrillation with heart failure.  All of us really have to be very cautious， cautious in a way of being very cognizant to do no harm first.  Many of the therapies， whether they are medications or interventions potentially can cause harm especially in sicker patients and older patients.  We must define objectives before we offer the various therapies for patients with heart failure in the setting of atrial fibrillation.  Then the third related issue when it comes to atrial fibrillation is stroke prevention.  We are going to have topics on stroke prevention in patients with atrial fibrillation.  There are several of new anticoagulants for the use of stroke prevention in atrial fibrillation.  That is very exciting.  There is also the interventional approach for patients with atrial fibrillation that is targeting the removal of atrial appendage from the circulation.

 

　　Shen博士：可以。我刚才提高的心房颤动及心力衰竭是美国三大比较流行的心血管疾病中的两个。就心房颤动而言，我一直认为其不是一种单一疾病，而是很多疾病的共同结果，只不过临床表现为心脏节律异常而已。因此，治疗心房颤动的同时，积极解决和治疗原发病及相关疾病具有重要意义。与合并其他心脏疾病者相比，在不伴有其他明显心脏疾病的患者中，鉴于大多数情况下，这些患者更健康、更年轻，拥有更多的治疗选择（可采取药物治疗也可采取介入治疗如消融），故治疗心房颤动时可采取不同的策略。虽然过去10~15年间心房颤动介入治疗取得了显著进步，但仍有很长的路要走。就合并心脏疾病（如今天上午大会上所提到的心力衰竭）的心房颤动患者而言，我们治疗时真的需要非常谨慎，首先要确保治疗对患者没有危害。很多药物治疗或介入治疗方法都可能会为患者带来伤害，尤其是在病情较重及老年患者中。因此，在为合并心力衰竭之心房颤动患者提供治疗前，应首先确定治疗目标。谈及心房颤动就不得不提到卒中预防。本届大会也将有很多有关心房颤动患者卒中预防的内容。令人兴奋的是，目前已经有几种新型抗凝药均能用于心房颤动的卒中预防。此外，目前针对心房颤动患者也有了介入干预方法即左心耳封堵术，通过结扎左心耳或手术切除左心耳的方法来实现。