<International Circulation>:Is it your opinion that implantable cardiac defibrillators are being overused?

  《国际循环》：您认为目前存在ICD滥用现象吗？

    Dr Iwai: That’s a tough question to answer. I think the problem with that lies in the healthcare system and the incentives and disincentives， as it were， that are placed on physicians from multiple angles. A lot of patients are demanding devices and even though they demand it and we tell them that it is not appropriate， they will go doctor shopping so they might find someone who will agree to it. Ejection fractions by echocardiogram or other measures can be somewhat subjective and also given variation in the level of expertise of the reader， there can be misinterpretations of left ventricular function as well as congestive heart failure class. So I think there is some overuse of ICDs. I do， however， want to point out that the recent article published in JAMA was somewhat misleading and I would point you to the Heart Rhythm Society for a statement regarding this.

    Iwai博士：这是一个很难回答的问题。我认为，问题在于医疗保健系统以及激励和约束机制。很多患者在咨询ICD装置，即使他们要求植入ICD，若我们告诉他这不合适，他们也可能找到某个会同意使用此装置的医生。超声心动图或其他检查测定的EF可能比较主观，医生的专业知识水平也存在差异，对左室功能以及CHF分级可能出现偏差。因此我认为，可能存在ICD过度使用现象。然而，我需指出，近期发表在JAMA上的一篇文章可能会对临床医生造成误导，心脏节律协会就此发表了一个声明。