Yoshito Iesaka教授  日本土浦市共同社医院

　　<International Circulation>: How do you see the high postoperative recurrence rates of atrial fibrillation， especially chronic atrial fibrillation?

　　Prof. Yoshito:Iesaka: In my laboratory， the recurrence rate after the first procedure is 65 percent – this is very high. But after the final procedure， the recurrence rate is 25 percent -- roughly 75 percent of patients can keep this recurrence rate within 1 year.  But we don’t have many cases. Many patients have to be followed up with to get the recurrence rate. But compared with the literature of other institutions， I think the rate is similar or a little bit higher than in other institutions. Our operation procedure is very short， compared with the Germans. They do the operation very intensely， and it takes 3 to 4 hours. In our lab， 2 hours and 20 minutes is the average procedure time.  And also， fluoroscopic time is less than 30 minutes.

　　《国际循环》：您如何看待心房颤动（房颤），尤其慢性心房颤动存在术后复发率高的问题？

 　　Yoshito Iesaka教授：在我们实验室中，房颤首次手术后复发率为65%，这是非常高的。但是在最后一次治疗后，其复发率会降至25%，大约75%的患者能在1年内维持在上述水平。但是我们的案例并不多，需要对患者进行随访才能获悉其复发率。与其他机构发表的相关文献所报道的复发率相比，我认为我们机构中的房颤复发率与其相当或略高一些。与德国相比，我们的手术时间非常简短。德国手术耗时较长，一般需3~4小时。而我们实验室中，平均时间仅为2小时20分钟。透光时间不超过30分钟。

　　<International Circulation>: What progress has been made with the mechanism of chronic atrial fibrillation? What ablation should be done besides circumferential pulmonary vein isolation?

　　Prof. Yoshito:Iesaka: There is a big controversy concerning the mechanism of chronic atrial fibrillation， particularly its driving mechanism. One is the multiple macro-reentry wavelets and the other is focal impulse or rotors. We perform predetermined sequential linear ablation in conjunction with circumferential pulmonary vein isolation (CPVI)， because the result of the MAZE procedure is excellent. Initial MAZE procedures had a success rate of maintaining sinus rhythm was higher than 95%. Afterwards， there is still an 87 or 89 percent success rate. That’s why we do the sequential linear ablation besides portal vein (PV) isolation. PV isolation is important. We have to consider， “Why do we need PV isolation?” The initial paper of Dr. Ha?ssaguerre showed that more than 90% of patients have a pulmonary vein trigger in the case of fibrillation. Actually， we make extensive linear circulatory ablation regions around the pulmonary vein antrum， because we expect compartmentalization effect of the pulmonary veins and its surrounding areas not only for confining pulmonary vein triggers.

　　《国际循环》：目前，慢性房颤维持的机制有何进展？在消融治疗中除环肺静脉隔离（CPVI）之外还需要进行哪些消融？

　　Yoshito Iesaka教授：慢性房颤的发病机制一直存在较大争议，尤其是其驱动机制，一是多子波折返，还有局灶冲动或局部转子等。实施预先确定的连续线性消融联合环肺静脉隔离（CPVI）的MAZE术效果很好。最初MAZE术维持窦性心律的成功率可达95%以上，之后治疗成功率也能维持在87%~89%。这是我们为什么除环肺静脉隔离（CPVI）之外进行连续线性消融的原因。CPVI非常重要，但我们需要知道为什么需要进行CPVI。Ha?ssaguerre博士的文章显示，90%的房颤患者伴有肺静脉激动。我们期望隔离肺静脉及其周围区域不仅仅对限制肺静脉激动有效，因此，需要在肺静脉前庭周围区域进行广泛的线性消融。

　　<International Circulation>: How do you think we can improve anticoagulant strategies before and after atrial fibrillation ablation for AF and specifically， which patients need anticoagulant therapies after ablation?

　　Prof. Yoshito:Iesaka: At present， we stop using warfarin 3 days or a new oral anticoagulant one or a half-day prior to the ablation procedure. The patient is admitted 1 day before the procedure， and is kept on a heparin for one to half-day， then ablates. We start a new oral anticoagulant immediately after the procedure， and last for 3 to 4 days， after which time we return to warfarin administration. Oral anti-coagulant is very expensive， so it is not yet a preferred therapy due to these financial considerations.

　　《国际循环》：您认为心房颤动消融术前后的抗凝策略如何制订，术后哪些患者需要继续抗凝治疗？

　　Yoshito Iesaka教授：患者消融治疗前3天停用华法林或0.5~1天停用新型口服抗凝药，术前1天住院，住院后采用肝素抗凝0.5~1天，然后行消融治疗。术后立即使用新型口服抗凝药，并持续应用3~4天，然后再改用华法林，因为口服抗凝剂是非常贵的，基于经济考量，并不将其作为首选。