[ACC2011]房颤消融后的抗凝治疗——Kenneth A. Ellenbogen教授专访
许多危险因素可以导致房颤发展。对许多患者来说,射频消融术可以在很长一段时间内控制这种心律失常,但随着时间的推移,房颤可能再次发生,这就是为什么要处理这些危险因素的原因。
International Circulation:Though catheter ablation can cure atrial fibrillation, it can’t ablate risk factors of atrial fibrillation. How do we effectively deal with these risk factors after ablation in order to prevent the recurrence of atrial fibrillation?
《国际循环》:尽管导管消融治疗可以治愈房颤,但是却不能消除房颤的危险因素。为预防房颤复发,如何有效地处理这些的危险因素?
Dr. Ellenbogen: There are risk factors that contribute to the development of atrial fibrillation. AF can be ablated which seems to control the arrhythmia in many patients for very long periods of time but it can come back over time which is an important reason to treat these underlying risk factors. However, it is not really clear that by treating risk factors (obesity, sleep apnea, and hypertension) that you necessarily reduce the risk of atrial fibrillation back to the level of someone who doesn’t have the risk factors. A very important part of taking care of a patient with AF is ensuring that all of the factors that predispose to AF, like hypertension and sleep apnea and obesity, get treated. Treating them is important because it prevents cardiovascular disease, but there is no guarantee, in fact it is rare that AF will go away because it has been years and years of factors that have contributed to that. In the same way, putting a stent in a coronary artery doesn’t treat the risk factors that cause coronary artery disease as the coronary artery disease can still be present and because a patient is on a lipid-lowering agent doesn’t mean five years from now they won’t have another cardiac event. It is the same principle.
Dr. Ellebogen:许多危险因素可以导致房颤发展。对许多患者来说,射频消融术可以在很长一段时间内控制这种心律失常,但随着时间的推移,房颤可能再次发生,这就是为什么要处理这些危险因素的原因。然而,这并不表明通过处理这些危险因素(肥胖、睡眠呼吸暂停综合征和高血压)就一定可以将房颤的发生率减少到与无危险因素相同的水平。治疗房颤最关键的是治疗诸如肥胖、睡眠呼吸暂停综合征和高血压等易患因素。去除这些危险非常重要,可以防止心血管疾病的发生,但也不能保证。事实上,房颤很少能被消除,因为年龄本身就是房颤的危险因素,随着年龄的增长,房颤的发生率不断增加。相同的道理,冠状动脉介入治疗(PCI)同样也不能消除引起冠状动脉疾病的危险因素,它仍然存在;现在正给予降脂治疗的患者并不意味着今后5年内,他们不会发生新的心血管事件。