1. <International Circulation>: Over the past few years， treating atrial fibrillation with radiofrequency catheter ablation has made great progress. With the Maturity of this Technology and innovation， more and more people take advantages of it. What do you think about the radiofrequency catheter ablation and minimally invasive heart surgery for atrial fibrillation treatment?
《国际循环》：最近几年，经导管射频消融治疗房颤取得了巨大进展。随着技术的逐渐成熟，越来越多患者从中获益。您能就经导管射频消融和微创外科方法治疗房颤这两种方法谈谈您的感想吗？
Prof. Peter Kowey：The principle ways that we now treat atrial fibrillation non-pharmacologically， that is without drugs， are catheter ablation as you said and minimally invasive cardiac surgery Both of these techniques are engineered to try to do one of two things， either eliminate triggers for the arrhythmia or to interrupt reentrant pathways that exist in the atria that perpetuate the arrhythmia or both. The way this is done is fairly crude because we do this anatomically that is without necessarily knowing where the AF is coming from. We ablate an area that we think it is coming from. And we do it empirically. That’s clearly not the best approach. It’s OK because we are successful 60% or 70% of the time with these techniques in our patients with paroxysmal AF. But we would really like to do much better than that. The key to the success of the procedure is identifying individuals who are likely to respond to one of these techniques that we use. And right now our selection is relatively crude. We would like it to be better.
There are no data to say that catheter ablation is necessarily better or worse than surgical ablation. There are no randomized， prospective， controlled trials to say that one is necessarily superior or inferior to the other. What makes the decision about which one the patient has is usually that the physician is recommending it. If the physician happens to be in a center where catheter ablation is the strongest technique， then patients generally get that procedure. Whereas if patient are seen in a center where surgery is done more frequently， then they are usually given to the surgeon. But as I said there is very little to choose between the two with regard to either efficacy or safety.
Peter Kowey教授：目前房颤的非药物治疗主要包括经导管射频消融治疗和微创外科治疗。这两种治疗都是从两方面着手，即去除房颤诱发因素或是切断使房颤永久存在的心房内折返通路，或两者兼而有之。由于是从解剖学上进行操作，无法确定房颤的真正起源部位，因此手术相对粗糙。根据经验对推测的房颤起源部位实施消融显然不是最佳的治疗方法。由于60％～70％的阵发性房颤患者治疗有效，我们认为这些技术是可行的。但是我们想做得更好。而治疗成功的关键在于确定对导管射频消融治疗或微创外科治疗可能有反应的患者。目前，病例选择还相对粗糙，我们期望改善这种状况。当前还没有数据证实导管射频消融治疗与微创外科治疗的优劣。亦没有随机、前瞻性的对照试验支持哪种治疗更好。通常是根据内科医生的建议来决定患者的治疗方式，如果该医生所在的医疗机构已经广泛开展外科手术治疗，通常对患者实施外科手术。但是，正如前面所提到的，两种治疗的疗效和安全性难分高下。
2. <International Circulation>: As a new long-acting antiarrhythmic drug without iodine， Celivarone has an electrophysiological profile similar to amiodarone. Would you like to evaluate when it will be approved by the FDA to treat ventricular arrhythmias or atrial fibrillation?
《国际循环》：作为一种长效不含碘的抗心律失常药，Celivarone具有与胺碘酮相似的电生理特性。你能否估计何时该药能够被FDA批准用于治疗房颤或室性心律失常？
Prof. Peter Kowey：Celivarone is one of several drugs that have been developed with the following idea， basically to take amiodarone and by changing the molecule， and in this case taking out the iodine moiety from the molecule to try to make amiodarone safer， but preserving its efficacy. Dronedarone is the first drug in that line of drugs that’s been under clinical investigation. Celivarone is the successor to dronedarone， another in a long line of drugs that will be studied in the next few years that will attempt to do what I just suggested， which is to have efficacy comparable to amiodarone， but without the same toxicity. Celivarone is early in development. It’s in phase II clinical development which means that there is much more to be done with that drug before we could ever see it becoming approved. But there is some cautious optimism based on what we know about it so far that it will be a good drug. One of the things that have been very encouraging about it is that it appears to be very safe， that is it does not appear to cause the toxicity that we see with amiodarone. What really limits amiodarone more than anything else is its toxicity. It is clearly an effective drug， but the toxic effects of the drug really limit its use. So what we are hoping that with dronedarone as well as celivarone is that we will see better safety and better tolerability. And therefore hopefully better utility of the drug over the long term. But it’s early days yet for Celivarone， we have a lot more work to do.
The paper that I presented here at this meeting on Celivarone has to do with preventing ICD shocks or discharges in patients who have ventricular arrhythmias. Patients who have ICDs can have discharges from the device that are very distressing to them. Some occur so frequently that these patients need to be treated with a drug to suppress the arrhythmia. The paper I presented here was proof that Celivarone does in fact suppress some of the arrhythmias that people with implantable defibrillators have.
Peter Kowey教授：根据改变胺碘酮分子结构这一思路，已经开发出一系列药物，其中包括Celivarone。Celivarone是不含碘的胺碘酮衍生物，去掉碘是为了增加胺碘酮的安全性，同时保持其疗效。在这一系列药物中，决奈达隆（dronedarone）率先进入临床观察。Celivarone是决奈达隆的衍生物，也是未来几年内可能会上市的药物之一。这些药物拥有与胺碘酮相似的疗效，但是毒性弱于胺碘酮。目前Celivarone还处于早期研发阶段，正在进行II期临床试验，这意味着距离该药上市还有很长一段时间。但是，根据Celivarone现有的数据，目前对于Celivarone是有效的抗房颤药物这一观点持谨慎的乐观态度。令人鼓舞的是，Celivarone具有良好的安全性，不引起胺碘酮常见的毒性反应。而毒性反应是限制胺碘酮应用的最重要因素。显然胺碘酮是有效的药物，但是毒性作用限制了胺碘酮的应用。因此，我们希望Celivarone和决奈达隆能够具有更好的安全性和耐受性。期望这两种药物在未来能够得到广泛的应用。但是，目前谈论Celivarone的应用还为时尚早，还有很长的路要走。本次会议上我递交的论文是关于Celivarone减少室性心律失常患者植入式心脏除颤器（ICD）的放电。除颤器放电使植入ICD的患者异常苦恼，很多患者都发生ICD放电。因此，患者通常服药以抑制心律失常。我们的研究证实，Celivarone能够抑制ICD植入患者的某些心律失常。
3. <International Circulation>: CRT is increasingly used for treating heart failure in recent years， this also is a hot topic debated in this meeting， would you like to talk about it?
《国际循环》：近年来CRT被越来越多地用于治疗心力衰竭， 在这次ACC大会上有关这一话题有激烈的争论。请您谈一下这方面的情况。
Prof. Peter Kowey：Cardiac resynchronization therapy (CRT) is clearly an effective treatment for patients with heart failure. The majority of p