International Circulation: What is your opinion on the use of Warfarin in all patients following ablation of atrial fibrillation? Is it a necessity?

　　《国际循环》：房颤消融后是否每个患者都需要服用华法林?您的观点是怎样的?

　　John Day: Although the HRS Atrial Fibrillation Consensus Statement recommends that all patients should be placed on Warfarin for two months afterwards， we have recently published a manuscript in the Journal of Cardiovascular Electrophysiology， showing that not all patients need to be on Warfarin. Rather we use Warfarin similar to the CHADS score recommendations. For example， if patients are cardioverted to sinus rhythm as part of their procedure， we will have them on Warfarin for 1 month. In patients who come to their procedure in sinus rhythm and have maintained sinus rhythm for the month prior to their procedure， and have a low CHADS score (0 or 1) we may just keep them on aspirin. Our strategy is to use Warfarin after an ablation based on risk factors rather than requiring all patients on Warfarin. Our high risk patients (CHADS Score of 2 or higher) or patients that have their atrial fibrillation cardioverterd as part of their procedure are placed on Warfarin.

　　International Circulation: Do you feel your strategy is better than the current recommendations， and if so， would you like to advocate your strategy?

　　John Day: In the consensus statement they did acknowledge that their recommendation that all patients should be on Warfarin was an empiric decision without hard evidence to support the recommendation. When we looked at our database， we saw that low risk patients do not necessarily have to be on Warfarin following an ablation. We observed that Warfarin use after atrial fibrillation ablation based on risk factors for stroke is a safe approach. It seems counterintuitive to require a 30-year old patient with rare episodes of paroxysmal atrial fibrillation and a normal heart (CHADS Score of 0) to be on Warfarin after the procedure. I cannot say that our strategy is any better， however， based on our experience in nearly 1000 patients， a Warfarin approach based on risk factors appears to be safe.

　　John Day教授: 美国心律学会房颤共识推荐所有患者导管消融术后应当服用华法林2个月，但这是一种基于经验的决定，没有坚实的证据来支持这个建议。我们最近在Journal of Cardiovascular Electrophysiology发表了一份报告，表明不是所有患者都需要华法林治疗。我们按照类似CHADS评分推荐的方法使用华法林。例如，如果患者在导管消融过程中通过电复律转为窦性心律，我们将让患者服用华法林1个月。而对于那些术前为窦性心律并且维持达一个月的患者， CHADS评分低(仅为0或1)，我们就只是让患者服用阿司匹林。我们的策略是导管消融术后是否服用华法林是依据危险因素，而不是要求所有患者使用。我们认为高危患者(CHADS评分≥2)，或者在消融过程中需要电复律房颤的患者才需要服用华法林。要求一名30岁伴极少发作的阵发性房颤、心脏结构正常、CHADS评分是0的患者在术后服用华发林，似乎并不合理。根据我们的数据库，低风险患者群在导管消融术后没有必要使用华法林。我不能说我们的策略更好，但是根据我们接诊的将近1000例患者的经验来讲，根据危险因素使用华法林的方案应当是安全的。