International Circulation: Could you give us a brief introduction of anticoagulation strategy before ablation， in the procedure and following up the ablation?

　　《国际循环》：您能介绍一下室性心动过速导管消融治疗的抗凝药物应用策略，消融术前、消融术中、消融术后分别有哪些要求?

　　Young－Hoon Kim: Except in emergent cases， we do not need strict anticoagulation before VT catheter ablation. Once we insert the catheter into the ventricular， we obviously need full anticoagulation therapy as well as need to check the ACT regularly. Usually we maintain the ACT around 300 second. After the procedure post-ablation anticoagulation therapy is more important. In patients with significant left ventricular dysfunction with a left ventricle ejection fraction less than 30%， you need to anticoagulate for 6-8 weeks followed by switching anticoagulant therapy to aspirin or other similar agent. It depends on each individual patient’s hemodynamics. For low-risk patients with a structurally normal heart anticoagulation after abalation is not a big issue and is not needed. For some post-myocardial infarction patients whose ejection fraction is still well maintained， antiplatelet is going to be the alternative rather than giving strict anticoagulation after ablation.

　　Young－Hoon Kim教授：除非是紧急状况，我们在VT导管消融术之前不需要严格的抗凝方案。一旦将导管插入心室，就需要完全的抗凝方案，并常规检查活化凝血时间ACT。通常，我们将ACT控制在300秒。消融术后，抗凝治疗更加重要的。如果患者有严重左心室功能不全，左心室射血分数少于30%，那么就需要抗凝治疗6~8周，然后才转为应用阿司匹林或其他同类药物进行。这依据患者个体的血流动力学情况。对于心脏结构正常的低风险患者，消融术后抗凝是不需要的。对于某些心肌梗死后的患者，如果射血分数保持较好，消融术后抗血小板治疗就是更好的选择而不是严格的抗凝治疗。对于伴有卒中、严重左心功能不全等高危因素的患者而言，华法林依然是标准的抗凝药物;对于低风险患者，阿司匹林是更合适的选择。