[AF-FORUM] 38E房颤射频消融

[AF Symposium]

-亲爱的Cohen医生：传统意义上来说，房颤消融术被认 
为是阵发性房颤的二线治疗方法。然而因为该方法安 
全、可靠、重复性好，房颤消融越来越可能成为一线 
治疗方法。以前就有一个多中心的试验来观察比较一 
线药物治疗和射频消融对阵发性房颤的疗效。现在， 
我仍然会对病人说消融术是房颤的二线治疗方案，但 
是持续药物治疗的门槛已经大大下降。例如，在考虑 
射频消融前我只会尝试一种药物而不是2种或更多。 
甚至，即使一个房颤病人使用胺碘酮后病情稳定，我 
仍会对其采用消融治疗来避免长期使用胺碘酮而带来 
的毒副作用。同样，如果一个病人使用任何一种其它 
药物病情是稳定的，但是不能耐受其副作用的话，我 
还是会考虑射频消融术的。另外还有一些特殊案例， 
如运动员、飞行员等等，对他们来说药物治疗是不可 
行的，只有消融术才是一线治疗方法。总之，我们确 
定无疑的正向消融这个方向迈进，如果下一版的指南 
中消融术成为房颤一线治疗方法，我也不会引以为讶。
Atul Atul Verma, MD FRCPC93
Denlow BlvdToronto, Ontario, M3B 1R1atul.verma在utoronto.ca

--
Dr. Sergio Dubner科委会主席
Dr. Edgardo Schapachnik组委会主席


 > 射频消融术是阵发性房颤的首要选择吗？

 > Warren Cohen> 美国得克萨斯州
施根灵译 王玲洁校



38E Dear Dr. Cohen,

Traditionally, AF ablation has been considered "second-line" therapy  
forparoxysmal AF.  However, as the safety, reliability, and  
consistency ofthe approach has improved, there has been more of a  
push for making itfirst-line.  At the present time, there is a  
multicenter trial lookingat comparing first-line drug therapy to  
ablation for paroxysmal AF. For now, I still tell patients that  
ablation is "second-line" but thethreshold for persisting with drugs  
has dropped immensely.  For example,I only try one dug before  
considering ablation (rather than 2 or more).Furthermore, even if a  
patient is stable on amiodarone, I will proceedto ablation to avoid  
long-term toxicities of amio.  Also, if a patientis stable on any  
drug but cannot tolerate the effects, I will go toablation.  There  
are also some special cases - athletes, pilots, etc -where drugs are  
just not feasible and ablation is first-line. In other words, we are  
definitely moving in that direction and it wouldnot surprise me if it  
is first-line in the next set of guidelines.
Atul. Atul Verma, MD FRCPC93
Denlow BlvdToronto, Ontario, M3B 1R1atul.verma在utoronto.ca

--Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo SchapachnikPresident of Steering Committee


 >> Is radiofrequency ablation the first option in the treatment of>  
paroxysmal AF?>> Warren Cohen> Texas, USA

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee