International Circulation: We are here with Dr. Munger.  I am glad you could join us today.  Could you please give us an overview of the main progress of VT ablation in 2014?

　　《国际循环》：非常高兴Munger 博士在此接受《国际循环》的采访。能否请您概述一下，2014年室性心动过速（VT）消融治疗取得了哪些重大进展？

　　Dr. Munger: VT ablation most of it is done for patients with structural heart disease even now. Particularly here in China as the adoption of both defibrillator technologies as well as the increase in coronary vascular disease has lead to more patients with coronary infarctions， we are seeing more patients here like in the West with reentrant ventricular arrhythmias. The incidence is going up here. As far as the treatments we have more tools to assist us in the ablation of these patients.  Mapping systems have assisted greatly in the last 10 years in identifying the source for these ventricular arrhythmias as well as work to target our ablation lesions.  Most of these lesions are placed on the inside of the heart but with new techniques of allowing us to access the outside of the heart we can also apply lesion sets there as well. On the horizon as far as what is being used for VT ablation there is needle catheter that is being developed that should allow us to apply lesions throughout the whole thickness of the ventricle that would allow for full thickness ablation of the heart and also help us with increase of the success of that procedure at this point in time.

　　Munger 博士：目前来说，VT消融大部分是在合并器质性心脏病的患者中开展的。尤其是在中国，随着除颤器技术的应用以及冠状动脉血管疾病的增加，很多VT患者合并心肌梗死。因此，与西方一样，中国有越来越多的患者存在折返性室性心律失常，室性心律失常发病率不断增加。就治疗而言，我们现在已经拥有很多可以帮助我们来实现对这些患者进行消融治疗的工具。在过去十年中，测绘系统在识别室性心律失常起源及实现靶病变消融方面给予了我们很大的帮助。大部分病变都位于心脏内部，目前，能穿透整个心室壁实现对所有病变进行消融的枕头导管正在研发用于VT消融，将有助于实现对心脏实现全层消融，有利于提高目前消融治疗的成功率。

　　International Circulation : So we are making some progress there?

　　《国际循环》：那在这方面我们将取得一些进展？

　　Dr. Munger: Yes we are making some progress.

　　Munger 博士：是的。

　　International Circulation: That is good.  There is both percutaneous catheter and surgical maze ablation.  They are effective treatments for atrial fibrillation but how about the incidence of post operative AF AT incidents? Does this post operative AF AT have the same or different mechanism in origin?

　　《国际循环》：就消融治疗而言，经皮导管及外科改良迷宫消融术均是心房颤动的有效治疗方法，两种治疗方法术后心房颤动/房性心动过速（AF/AT）的发生率如何？其术后房性心动过速的发生机制及起源是否相同？

　　Dr. Munger: Sure the question about either post ablation catheter or post surgical ablation of atrial fibrillation continues to be a problem.  AF ablation at this point in time， one procedure can be expected to assist for benefit patients only 60% of the time.  We still have a significant amount of patients who return to see their electrophysiologists within 6 months to a few years with post ablation or post surgical ablation atrial arrhythmias.  These arrhythmias are a bit different from the arrhythmias that the patients first came in with.  Some are due to routine atrial fibrillation or due to a recurrent conduction out of the pulmonary veins but many of them are due to new atrial arrhythmias circuits that develop around the scar tissue that has been placed by the initial ablation.  It is important to know the typical types of arrhythmias that one expects to find in these patients before we actually go in to the procedure.  That has been very well characterized over the last 5 years we have a pretty good idea of where to start looking to treat these new arrhythmias that show up in these patients.

　　Munger 博士：经皮导管及外科改良迷宫消融术均存在一定的问题。经皮导管或外科改良迷宫消融术后，仍然会有很多患者在术后6个月~数年内因房性心律失常而再次就诊。但这些再发的术后房性心律失常与患者首次出现的心律失常有所不同。从机制上而言，有些是应因心房颤动或肺静脉再传导所致，但很多却是由消融所致疤痕组织周围形成的新房性心律失常回路所致。因此，在实施消融术前，重要的是要先确定心律失常的类型。在过去5年中，我们积累了大量的经验，可根据患者特征确定从何处开始消融来治疗上述新发心律失常。

采访概要：

　　室性心动过速消融治疗进展--美国Mayo Clinic Thomas Munger教授专访

　　目前，室性心动过速（VT）消融大部分用于合并器质性心脏病的患者。尤其在中国，随着除颤器技术的应用以及冠状动脉血管疾病的增加，很多VT患者合并心肌梗死。因此，与西方一样，中国有越来越多的患者存在折返性室性心律失常，室性心律失常发病率不断增加。就治疗而言，现在已拥有很多可帮助医生实现对这些患者消融治疗的工具。过去十年标测系统在识别室性心律失常起源及实现靶病变消融方面给予了我们很大帮助。大部分病变都位于心脏内部，目前，能穿透整个心室壁实现对所有病变消融的大头导管正在研发用于VT消融，将有助于实现对心脏实现全层消融，有利于提高目前消融治疗的成功率。

　　经皮导管或外科改良迷宫消融术后，仍会有很多患者术后6个月至数年内因房性心律失常再次就诊。但这些再发的术后房性心律失常与患者首次出现的心律失常有所不同。机制上，有些是因心房颤动或肺静脉再传导所致，但很多却是由消融所致疤痕组织周围形成的新房性心律失常折返所致。因此，消融术前，重要的是要先确定心律失常类型。过去5年我们已积累大量临床经验，可根据患者特征确定从何处开始消融治疗上述新发心律失常。