《国际循环》：就电生理及起搏领域而言，ESC 2014年会上有哪些精彩内容及亮点？

　　International Circulation: In the field of arrhythmias and pacing， what were the highlights from ESC2014?

　　Vardas教授：ESC 2014年会上有很多有关心律失常的发言，但我想重点总结的是起搏领域的一些重要信息。在起搏领域，无线起搏器正逐渐成为现实，越来越多的公司在推出这方面的新产品。在ESC 2014年会上医生们有机会听到了有关无电池起搏器的相关内容。这种无电池起搏器仍处于实验阶段，其无需应用电池，可应用心脏本身的能量进行工作。无线起搏器与无电池起搏器这两种新设备是心脏起搏领域两个非常重要的发现和成果，故而成为大会的特点话题。

　　Dr Vardas: We had a lot of presentations related to arrhythmias at the Congress. However， I would like to summarize that content with some important messages which came from the pacing field. It seems that the leadless pacemaker is becoming a reality and more companies are coming up with new products. We had the opportunity to also hear about the battery-less pacemaker. This is still experimental at the moment but it uses the energy of the heart itself and has no battery. These two devices are really important for the field of pacemakers. So battery-less pacemakers and leadless pacemakers were very much the hot topics of the Congress.

　　《国际循环》：根据心房颤动的卒中预防（SPAF）研究的结果，在进行房颤卒中预防时临床医生应如何在华法林、新型口服抗凝药、抗血小板药物及不用药之间作出选择？

　　International Circulation: According to the results of the SPAF study， how should clinicians choose between warfarin， new oral anticoagulants， antiplatelet agents or using nothing?

　　Vardas教授：就这个问题，两年前ESC专门发布了相关指南，并作了如下推荐：首先，对阵发性或持续性心房颤动患者应采用CHADS-VASc评分予以评估，对评分≥2的患者则应采用抗凝剂进行治疗，而评分为0的患者则不需要接受任何治疗，评分为1的患者则可以应用抗血小板药物或抗凝药进行治疗。至于就抗凝药物而言，应选择何种类型的药物？我们说，对现在刚开始进行抗凝治疗的患者而言，推荐应用达比加群、利伐沙班及阿哌沙班等新型抗凝药。对原来应用维生素K拮抗剂治疗的患者，ESC指南则推荐要评估患者应用维生素Ｋ拮抗剂后感觉是否好以及INR是否处于2~3的范围内。如果感觉还可以则可以继续应用；如果患者应用后因多种原因感觉不好或是INR一直不能控制在2~3的范围内，则需换用新型抗凝药物。

　　Dr Vardas: For this question， I can easily reply by saying that two years ago， the European Society of Cardiology published new guidelines. In these guidelines， we proposed the following points. Firstly， patients with paroxysmal or permanent atrial fibrillation should be evaluated according to the CHADS-VASc score. We suggest any patient with a score of 2 or more should be treated with real anticoagulants. Patients with a score of 0 do not need to receive any treatment. Patients with a score of 1 can receive either antiplatelets or anticoagulants. What types of real anticoagulants should be used? The answer is for all those patients who start treatment today， the new anticoagulants like dabigatran or rivaroxaban or apixaban are recommended. For those patients who have already been using the vitamin K antagonists， the recommendation of the ESC is to determine if they are doing well on the vitamin K antagonists (i.e. the INR is 2-3) and if this is the case， then physicians should continue with that regimen. However， if patients are not happy because of the vitamin K antagonists for different reasons， or if the INR is not between 2 and 3 all the time， then the physicians should replace therapy with the new anticoagulants.

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