编者按：长期以来，关于心房颤动（房颤）的心率和节律控制问题争论不休。本届美国心脏协会（AHA）2015科学年会上，克利夫兰诊所Mina Chung教授就这一话题做了专题报告。Chung教授是牵头了多项房颤、室上和室性心律失常、电复律、起搏器和除颤器治疗重要研究。另外，Chung与其克利夫兰诊所同事一起首次报道了炎症与房颤持续性的关系。另外，她也是AFFIRM（房颤节律管理随访调查）研究的主要研究者之一。本届AHA会后，Chung教授应邀接受了《国际循环》的采访。
Dr. Mina Chung: Mina Chung. I am a clinical cardiac electrophysiologist， a staff at The Cleveland Clinic， and Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Mina Chung教授：我是Mina Chung，是克利夫兰诊所临床心脏电生理学家，也是美国凯斯西储大学克利夫兰诊所勒那医学院的医学教授。
International Circulation: In your opinion， which is more important for the management strategies in atrial fibrillation， rate or rhythm， and why?
《国际循环》：您认为，在房颤的心率和节律控制方面，哪个更重要？为什么？
Dr. Mina Chung: Well， we have to rate control everybody， but I think it is most important to consider a rhythm control strategy along with that. This is a very old topic that has been debated for a couple decades， and there was a big randomized trial， as many people know， called AFFIRM. That was now published I think over 13 years ago. In that study， that was the largest study of atrial fibrillation to date. It randomized over 4，000 people to a rate versus rhythm drug control strategy. It was powered to detect differences in survival. There were no differences in mortality between the two arms， but there was a trend towards better survival in the rate control group. With that we saw some practitioners just leaving people in atrial fibrillation which can be a little difficult because even as we were a part of AFFIRM as well， I was encouraged that if somebody came to us with atrial fibrillation or new onset atrial fibrillation that we at least try to cardiovert or try to restore sinus rhythm even before randomization. What is difficult is that some practitioners started leaving people in atrial fibrillation and what that does is you get atrial remodeling and atrial enlargement and you do not know what will happen long term， and plus it decreases some of the success rates of the therapies that we do have for rhythm control. Not only drugs but now in 2015， we have pretty good therapies for atrial fibrillation ablation. Once your atrial fibrillation becomes more persistent and long standing persistent， then the success rate for a lot of these therapies is a lot lower. Many of us would prefer a rhythm control approach and that is even more important now in 2015 in going forward， because we do have some good therapies for rhythm control.
Mina Chung教授：我们每个人都需控制心率，但我认为，与此同时，更重要的是节律控制。这是一个非常古老的话题，已争论了长达数十年之久。众所周知，这方面有一项大规模随机试验，即AFFIRM研究。这项研究结果在大约13年前就已发表。那项研究是迄今为止规模最大的房颤相关研究。它将4000余例患者随机分至药物控制心率组或药物控制节律组。研究旨在检测有足够效力的生存率差异。结果发现，两组死亡率无差异，但心率控制组的生存率倾向于更好。但仅控制心率，对一些临床医生来说是困难的，即使我们作为AFFIRM研究参与者，若有房颤或新发房颤患者前来就诊，我们至少会对其进行心脏复律或尽量维持窦性心律治疗，即使在随机化之前。但问题是，房颤患者存在心房重构或心房扩大，其长期结局不能确定，若进行节律控制，则可增加治疗成功率。不仅仅是药物治疗，而且目前我们有非常好的房颤消融方法。一旦房颤演变为更加持续性和长期存在，这些治疗方法的成功率将大打折扣。我们大多数人会选择节律控制，节律控制在今后将更加重要，因为我们确实有控制节律的一些好方法。