International Circulation: It is being said that the success rate of catheter ablation on AF is around 60%. There is a lot of variation in success rate claims， but what do you think is the important next step that needs to be taken in catheter ablation technology in practice?
　　《国际循环》：据说AF导管消融的成功率是约60％。在所声称的成功率上有很大变化，但您认为在实践中在导管消融技术上需要采取的下一个重要步骤是什么？
　　Dr Hindriks: I agree. On average， the success rate of catheter ablation at short to mid-term follow-up (about 18 to 24 months) is approximately 60%. That is a correct but superficial look at the efficiency of catheter ablation because we see significant differences in different patient populations. If we look at patients with atrial fibrillation that come to the electrophysiologist in the very early stages of disease and have paroxysmal atrial fibrillation for up to two years but not as long as twenty years， these a patients can usually be treated very nicely with significantly better outcomes and success than those patients with advanced stages of disease (i.e. persistent long-standing atrial fibrillation for ten years). For these patients it is difficult because the substrate promoting atrial fibrillation is more advanced. What is the main problem? The main problem in catheter ablation currently is the durability of induced lesions. We know that once we have isolated the pulmonary veins there will be no more atrial fibrillation but there is reconduction into the pulmonary veins (both early and late reconduction)， resulting in recurrence of atrial fibrillation. I personally believe that contact sensing technology， steerable sheath technology and advanced radiofrequency energy transfer to target sites will reduce the problem of reconduction by more efficient and also faster induction of durable lesions.
　　Dr Hindriks：我同意这一点。平均来看，在短期到中期（约18~24个月）随访时导管消融的成功率约为60％。这是导管消融有效性的一个正确但缺乏深度的表观，因为我们在不同的患者群体中看到了显著差异。如果我们考察那些在疾病极早期阶段即找电生理医生就诊、且有长达两年而不是二十年的阵发性心房颤动的心房颤动患者，这些患者通常可以得到非常好的治疗，较那些处于疾病晚期阶段（即持续性长期心房颤动达十年）的患者有显著较好的结局和成功率。对于后面这类患者，治疗是困难的，因为促成心房颤动的基质更为晚期。主要的问题是什么？目前导管消融的主要问题是所诱发消融灶的耐久性。我们知道，一旦我们隔离了肺静脉则将不再会有心房颤动，但有导致心房颤动复发的到肺静脉的传导恢复（早期和晚期传导恢复）。我个人认为，接触传感技术、导向鞘技术和先进的至目标位置的射频能量传递，将通过更有效且更快诱导出持久的消融灶来减少传导恢复的问题。