进一步推进我国导管消融治疗心房颤动的临床研究

目前，心房颤动（房颤）治疗的研究方向主要有两个，一是导管消融，电生理学家力图通过不断改进消融术式，获取更好的消融效果，以期达到最终根治房颤的目的；二是药物治疗，许多药理学家则希望研制出副作用小、见效快、能长期抑制房颤的抗心律失常药物（AAD），部分对导管消融治疗房颤效果有疑虑的临床医师也对此抱有很大希望。

Promoting the clinical study of catheter ablation of atrial fibrillation in China

The most important research of treatment of atrial fibrillation (AF) is catheter ablation and drug therapy. In the past decade, catheter ablation made a rapid progress and became the most promising method to treat AF. But in the last few years, the development of ablation of AF seemed to be slow. The success rate of ablation of paroxysmal AF was not increased in recent years and the effects of ablation on persistent AF and longstanding persistent AF were even lower. In china, though the AF patients' number who accepted ablation was increased rapidly in the past decade, the success rate, especially the long-term success rate need to be roused. While the drug therapy seemed developing very quickly. Actually, ablation is superior to drugs according to most clinical research. The CABANA study reported in 2010 showed that,compared with optimal drug therapy,catheter ablation reduced the recurrence rate of AF. In CABANA study,60 AF patients randomized to drug therapy (87％ accepted AADs, 13％ accepted rate control) and catheter ablation. After 12 months of followup,the results showed that the ablation was superior to drug therapy in preventing symptomatic AF recurrence. In APAF2 study, researchers investigated the effects of catheter ablation and AADs on prognosis of paroxysmal AF. One handred and ninty-eight patients were enrolled in APAF2 study and divided into two groups. Circumferential ablation group and AADs group,99 patients in each group. The results showed that ablation eliminated the recurrence of AF and preventing the development of arrhythmia. In AADs group, almost all patients used amiodarone. Patients in AADs group who had no AF episodes after 4 years were less than 10％.The observation also indicated that long-term use of AADs may turn paroxysmal AF to persistent AF with lower quality of life and more hospitalization. Catheter ablation can also relieve atrial remodeling, preventing the development from paroxysmal AF to persistent AF. Tops et al. reported that the left atrial (LA) had reverse remodeling after catheter ablation. The LA strain rate also improved. Another META analysis including 17 studies showed that LAD and LA volume decreased significantly after successful catheter ablation and the left ventricle ejection fraction (LVEF) did not changed. Diastolic and systolic function of left ventricle were also improved. It was reported that nearly 50％ patients with paroxysmal AF who accepted drug therapy progressed to persistent AF. In a recent study, 504 patients with AF who accepted ablation were investigated. The results showed that only 0. 6％ patients in the studied cohort turn to persistent AF per year,the rate was significant lower than that of drug therapy. Though a lots of clinical studies showed that catheter ablation made more benefits to patients, how to increase the success rate of ablation is really a hard battle. More clinical trims should be done to win the battle.