International Circulation: In China， there many patients with AF， but both few are treated with anticoagulant therapy and compliance is low in those who are. Is it necessary to stress more on rhythm control and radiofrequency ablation， rather than rate control?
　　《国际循环》：中国有许多房颤患者，其中很少部分患者愿意接受抗凝治疗，而那些愿意接受的患者依从性也较差。那么是否有必要更加注重节律控制和进行射频消融，而不是心率控制呢？
　　Dr. Miguel Valderrabano: That is something I would love to say， but cannot. The reason is there is no real evidence that catheter ablation can prevent stroke. However， there is plenty of evidence that anticoagulants can prevent stroke. The studies that have been done with catheter ablation have most commonly targeted symptom control. In that regard， catheter ablation has proven to be effective but we do not know long term if the rhythm control you achieve with catheter ablation translates into preventing strokes. That is what the CABANA trial has set out to do. There is indirect evidence and case series that indeed the risk of stroke down the line with a successful catheter ablation is compared to controls but there is no randomized trial looking specifically at this in a more serious fashion. There is a of registry and retrospective data that seems to suggest that. At this point， it is not proven. This dilemma between rate and rhythm control occurs everywhere. Anticoagulants are very problematic. There is a lot of progress currently in non-pharmacological strategies for stroke prevention that may or may not affect rhythm. That has to do with targeting the left atrial appendage (LAA). The LAA is a pouch where clots form during AF that lead to stroke. There are several strategies aimed at getting the appendage out of circulation， either by plugging it or tying it off. I think we will be seeing more of that in the future. It’s a procedure that will have its own costs， but if it works， it should replace all of the oral anticoagulant. That is what a lot of companies are hoping for and are trying to create the proper device for this procedure. At this point， we are stuck with anticoagulation as the only proven treatment for prevention of stroke.
　　Miguel Valderrabano博士:这是一个我很想说但无法说的观点，原因是没有真正的证据表明导管消融可以预防脑卒中，却有大量的证据已证明抗凝剂可以做到。目前已完成的研究中，导管消融可控制目标症状，所以导管消融已被证实是有效的，但我们不知道导管消融达到的节律控制是否能长期预防脑卒中，CABANA试验已着手这方面的探究。有间接证据和系列病例表明，成功进行导管消融组患者与对照组患者相比，脑卒中的发生率确实有所下降。目前没有随机试验特别关注此观点，许多注册表和回顾性数据似乎能够表明，但无法证明。这种心率控制和节律控制选择的两难境地无处不在，而抗凝剂的使用又存在问题。目前脑卒中预防的后备策略有很多进步，其中可能影响或不影响心律，皆与左心耳(LAA)相关。LAA是一个袋状结构，房颤时血栓在此处形成，脱落可导致中风，有几种治疗策略旨在通过堵或结扎使LAA脱离血液循环，未来我们将看到更多。这个过程有一定成本，但如果成功的话，应该可以替换所有的口服抗凝剂，这正是很多公司都希望并试图创建适当的设备进行这个手术的原因。但目前，抗凝治疗是唯一证明可以预防脑卒中的措施。

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