Hugh Calkins教授  心脏节律协会（HRA）主席

　　Hugh Calkins : It is great to be here at the Great Wall meeting here in Beijing.

　　Calkins教授：很高兴能来北京参加长城会。

　　<International Circulation>: For the current HRS and CHRS at the Great Wall forum， what would you say are some of the more exciting information in presentations to be made this year?

　　Hugh Calkins: Well the combined forum is case based meaning that a series of patients are being presented that have common arrhythmia conditions or common arrhythmia problems and then we are discussing the management of these patients providing the latest literature and the best practices.  The topics range from ventricular arrhythmia and sudden cardiac death， to atrial fibrillation to inherited arrhythmias， and it really covers the spectrum of most types of cardiac arrhythmias.  The reason this format was selected is because not only if something is case based you tend to remember it more， if it is about a patient， but also one of the keys today that everyone talks about is patient centered care.  At the end of the day， it is all about the patient.  Researchers and studies in a vacuum do not really mean much; they mean something when you ask ‘well how does this impact optimal care’ from a particular patient.

　　《国际循环》：本届HRA-CHRS@GW-ICC联合论坛将为参会者提供哪些精彩内容？

　　Calkins教授：该论坛是以病例为基础的，主要与大家分享一系列常见心律失常病例，然后根据最新的文献及最佳临床实践标准对上述患者的管理进行讨论。其主题涉及室性心律失常、心脏性猝死、心房颤动（简称房颤）、遗传性心律失常等多种疾病，涵盖了心律失常的大多数类型。我们选择病例分析的形式，主要是不仅因为其有助于参会者记忆与学习，更是为了体现以患者为中心的服务原则。总而言之，整个论坛都是有关患者的。脱离现实的研究者及研究没有太大的意义，而本届论坛则通过特定的患者告诉您如何向患者提供最佳解决方案。

　　<International Circulation>:   I know your case was specifically about a 69 year old obese male and just after you a professor spoke about a very young healthy college athlete.  So it seems as though it is really spanning the patient range.  As you said before， patient centered care and individualized treatment， has been very important principal that has developed over the last few years of cardiovascular work.  In terms of patients with atrial fibrillation specifically， how would you best implement the overall treatment?

　　Hugh Calkins: Well I think there is no better example of patient centered care than in a patient with atrial fibrillation where every patient is quite different in terms of how much atrial fibrillation they have， if it is intermittent  or is it all the time.  They also differ in their symptoms.  Some patients have atrial fibrillation and feel terrible， other patients only have fatigue， and other patients have no symptoms at all.  Also patients vary in terms of their stroke risk.  One of the key management issues with atrial fibrillation is preserving the brain and preventing strokes.  So with every patient a physician needs to assess that particular patient’s stroke risk profile using what is called the CHA2DS2 VASc score so you look at the patient’s age， you determine if they have hypertention or heart failure or vascular disease and so forth， and based on that you make a specific recommendation for that specific patient.  It is all about patient centered care， the right treatment for the right patient at the right time， and I think the other new concept in medicine that is being thought about more is the team approach.  The idea of the healthcare team so physicians are one of many components of the healthcare time， you have nurses， you have technicians and so forth and to implement best practices really takes a team working together for the benefit of a specific patient.

　　《国际循环》：据我所知，您分享的是一个69岁的肥胖男性，在您之后另一位教授报告了一个非常年轻的男性运动员病例。看起来论坛所涉及的病例其年龄跨度非常大。正如您之前所说的，以患者为中心的服务及个体化治疗是心血管疾病的重要原则。就房颤患者而言，您认为应如何实施最佳的整体治疗？

　　Calkins教授：我认为房颤患者是最能体现以患者为中心的服务的主体，因为每个房颤患者的发作频率（是间歇性的还是持续性的）、症状均有所不同。有些房颤患者，症状较重；有些患者则仅有乏力表现；还有些患者可能并无症状。此外，房颤患者的卒中风险也存在差异。房颤管理的主要目的是保护大脑功能，预防卒中发生。因此，医生应询问患者的年龄，确定其是否伴有高血压、心力衰竭、血管疾病等，然后应采用CHA2DS2-VASc评分对每位患者进行卒中风险评估，根据评估结果对特定患者作出具体的推荐。这就是以患者为中心的服务，在合适的时间对特定的患者实施正确的治疗。还有一个应该重点关注的新医学理念就是团队协作。医疗团队应包括医生、护士、技术人员等，旨在通过团队合作为特定患者提供最佳解决方案，使其获益。

　　<International Circulation>:  Catheter ablation has also been used as a very important treatment for atrial fibrillation.  Could you please talk a little bit about some of the newer developments and utilizations for atrial fibrillation and on catheter ablation and how it has advanced?

　　Hugh Calkins:  The modern catheter ablation techniques really began about 15 years ago and in the past 15 years we have observed dramatic improvements both in the efficacy and the safety of the procedure.  Reflecting that the number of AF ablation cases performed worldwide is increasing dramatically.  That is certainly true in Europe and the United States and also in China.  I know that in China this procedure has been rapidly accepted and I think that speaks to the fact that it has become a pretty good procedure but it is still imperfect.  For catheter ablation for atrial fibrillation in an optimal candidate the success rate is somewhere around 70%.  In a poor candidate it could be as low as 30% so again patient specific treatment is important to determine if this specific patient in front of you a good candidate for this procedure or a bad candidate.  In terms of advances in catheter ablation I think there has been continued advanced in best practices in terms of preventing complications， how to handle anticoagulation prior to the procedure， during the procedure， and after the procedure and how to use the catheter safely and effectively.  There have been some advances in new technologies， there is a cryoballoon that is available now， or freezing balloon， RF (radio frequency) ablation continues to get better.  Soon we will have a catheter available that will actually monitor the force your catheter places on the wall of the heart so that is as far as I know， not yet available in China but I think it is will be available probably some time in the next year or two and that is an example of an incremental approach to catheter ablation.  Our goal is getting to 100% success with no complications.  We are not there yet but we are still working towards our goal.

　　《国际循环》：导管消融治疗是治疗房颤的重要方法。请您谈一下房颤导管消融的新进展。

　　Calkins教授：现代导管消融技术始于15年前，在过去15年间其疗效及安全性均得到显著的改进。与之相对应，全世界范围内房颤消融治疗的数量急剧增加。欧洲、美国及中国均是如此。据我所知，虽然在中国导管消融治疗很快被接受，并成为房颤治疗的较好选择，但仍不完善。对具有最佳适应证的房颤患者而言，导管消融治疗的成功率仅为70%左右。如果患者并无最佳适应证，导管消融治疗的成功率仅为30%。个体化的治疗是非常重要的，要对患者进行评估确定其是否适于应用导管消融治疗。就导管消融的进展而言，我认为在并发症预防、术前/术中/术后抗凝治疗及如何安全有效地使用导管等的最佳解决方案方面均取得了较大的进展。此外，新技术也取得了进步。现在已经有一种冷冻球囊能更好地实施射频消融。不久之后，我们还将拥有能够测量施加在心脏壁上的压力的导管。中国目前还没有这种导管，我相信在未来的1~2年内其可能将会上市。我们的目标是让房颤治疗的成功率达到100%，并且不伴有并发症。虽然我们现在还做不到，但我们将继续朝着这一目标努力。

　　<International Circulation>:  Sounds like there are a lot of exciting developments for people in the field of cardiology.

　　Hugh Calkins:  Yes I think this Great Wall meeting is a wonderful opportunity for physicians to come and hear about all the latest new treatment options， best practices， and also to interact with their colleagues and with the faculty that come here from around the world to attend this meeting.

　　《国际循环》：这样听来，心血管领域有很多令人振奋的进展。

　　Calkins教授：是的，我认为这次长城会对临床医生而言是一个聆听最新诊疗进展、与参加此次大会的世界各地之同道及专家互动交流的好机会。