Episode Transcript
Interviewer: A procedure called catheter ablation 降低房颤患者并发症和死亡的风险.
Announcer: 检查最新的研究，告诉你最新的突破. The Science and Research Show is on The Scope.
Interviewer: Today I'm talking with Dr. Nassir Marrouche from University of Utah Health 关于导管消融治疗心房颤动患者 heart failure.
AFib and Heart Failure
Dr. Marrouche: You know, 美国有超过2000万人患有心力衰竭, 这些人中有相当一部分人有射血分数或心肌虚弱, less than 35 percent. That's defined as weak heart muscle. 这些人心脏性猝死的风险很高. 大发娱乐知道这一点已经很多年了，这就是为什么他们需要保护它.
现在，超过30%的心力衰竭患者正在遭受或将要遭受 atrial fibrillation. It's a big number. Very enormous. So this is becoming a big dilemma, how to treat these patients, and we know that in this patient population, 房颤本身会增加死亡的风险, increases the risk of stroke and so on. And over the years, 已经有很多研究使用不同种类的药物来改善这些病人的结果.
In fact, 大发娱乐发表在《大发娱乐》上的论文表明，使用任何一种药物和不使用药物都没有区别. The mortality will stay the same. Stroke risk will stay the same. Hospitalization rate will stay the same.
Atrial Fibrillation Catheter Ablation
Interviewer: Catheter ablation is a completely different approach. Can you explain what that is?
Dr. Marrouche: Me, personally, 在大发娱乐来到犹他大学之前，大发娱乐的团队就已经开始研究这个了, around 1999, 2000, which is, simplified, is the catheter-based procedure, as the name says, to target specific cells within our heart, specifically in the atrial, the upper chamber of the heart, to cauterize or kill, trigger the tissue causing irregular heartbeat. There's different ways to do this, 在过去的20年里，大发娱乐学到了很多如何做到这一点，以及什么是最好的方法, 但是仍然有至少5到6种消融心房颤动的策略.
Catheter Ablation Procedure
Interviewer: 所有这一切都在几个小时内完成病人离开，或者 ...
Dr. Marrouche: If I would have given you this interview in 2000, when we were in the Cleveland Clinic, I would have told you 11 hours procedure to 10, nine. We went up to six, we were excited. It's a two-hour procedure today. I mean, the ablation itself, the delivering energy and heating tissue, is probably 45 to 90 minutes maximum.
Interviewer: 所以即使这个过程已经完成了, like you said, for about 20 years I think you said?
Dr. Marrouche: Mm-hmm.
Interviewer: 听起来真正不为人知的是它有多有效, especially compared to drug treatments.
Dr. Marrouche: The unknown, until we just presented the recent study was, does a-fib ablation, per se, 改善心力衰竭患者死亡率或恶化心力衰竭住院治疗的主要终点? Now, that's that we focus on, 因为大发娱乐想看看那些患有这种疾病的病人.
Interviewer: I see.
Dr. Marrouche: Not quick, but to look at . . . they have higher events. These patients die, about 30 percent, 其中40%的人死于心力衰竭和心脏疾病. 所以大发娱乐想看看这个人群，看看大发娱乐能不能挽救这些高危人群的生命? And that wasn't done until recently.
Catheter Ablation Outcomes
Interviewer: In a nutshell, what were those results?
Dr. Marrouche: 与基于常规指南的标准治疗相比，导管消融显示出全因死亡率的显著降低, standard of care treatment. Catheter ablation, 当你把死亡率和心力衰竭结合起来作为一个复合终点, 两者的复合点明显减小. When you looked at the hospitalization only, 在降低心力衰竭住院率方面，导管消融优于药物或标准护理治疗.
Catheter ablation was also, 这一点对听众来说也很重要, 降低心血管死亡的风险. 不是所有的都导致死亡，也包括心血管死亡.
Interviewer: Okay, specifically, yeah.
Dr. Marrouche: Sudden cardiac death and failing pump and so on. So that improved the outcome. 实际上，心血管疾病死亡率的相对风险降低了51%. That means that every other patient will recover. And what's important for causal AF, 如果你看一下数据，希望论文很快就会出来，你会读到它, we need only to treat eight patients to save . . .
Interviewer: Eight?
Dr. Marrouche: Eight patients to save one life. That's a big deal for a study like this.
Interviewer: 你之前提到的一件事是，我的意思是，这些病人已经病得很重了，对吧? 因此，即使在这个阶段，你也可以做出改变，这似乎很有影响力.
Dr. Marrouche: You have the data from causal. 大发娱乐越早治疗这个病人, in the stage of heart failure, the better the outcome. 所以如果你治疗他们，当他们开始心力衰竭时泵是30%和35%, 29 percent in function and ejection fraction, 当他们处于疾病的最后阶段时，他们会做得更好, when they're almost dying. So that's important as well, go and seek treatment as early as possible, 消融应该是这一人群的最佳选择.
Heart Failure and Atrial Fibrillation Research
Interviewer: And so what's next in this line of research?
Dr. Marrouche: 我对导管消融术感到非常兴奋，并在全世界推广它，因为大发娱乐的病人解决了这个问题, but I'm telling my colleagues and partners, 小心，不要爆炸，然后开始随机给每个人. 大发娱乐需要考虑选择这个病人和核磁共振成像, 在心房和心室发现纤维化组织和疾病的扩展将更好地大发娱乐重新定义该患者. 这是大发娱乐现在正在进行的下一个大型研究是根据患者心脏疤痕的数量随机分配患者, to ablation procedures or not, 看看主要终点是什么样子的, mortality, hospitalization, and strokes.
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