<International Circulation>:  Regarding the International Ablation Registry could you please provide us with a brief comment regarding its design， aims and application?
    Dr Riccardo Cappato: The international Ablation Registry was an initiative we started a few years ago to monitor as closely as possible the safety of catheter ablation for the treatment of atrial fibrillation. This technique has increased over the years and with it expectations among patients but its true impact on clinical practice was not established. There was a lot of enthusiasm at the beginning which was offset by a lot of criticisms later on and so it was time we thought to get as much information as possible from a variety of centres representative of daily clinical practice. Together with a number of prominent electrophysiologists we established a steering committee that generated a questionnaire that was circulated in more than 500 centres worldwide. Data on safety and efficiency were collected on a centre based prospective showing that between the years 2003 and 2006， 16000 patients underwent 20000 procedures in 85 responding centres in which programs for catheter ablation for atrial fibrillation treatment were run. The efficacy was pretty good at 70%， much better than the previous survey which collected data up to 2002 which showed a 52% success rate. An additional 10% success rate could be achieved by adding previously ineffective anti- arrhythmic drugs on top of catheter ablation. There were about 5% major complications and about 8% induction of new arrhythmias. Some interesting data coming from sub-analysis showing that if you ablate paroxysmal atrial fibrillation you will have a 43% higher probability of success than ablating persistent atrial fibrillation and a 60% larger probability of success compared to permanent atrial fibrillation. Safety can improve with physician experience where you can increase your capacity of being successful by 4% for every 30 procedures you add on top of your previous collective procedures you have done.  Using an irrigation catheter compared with the more traditional 4mm tip does not improve efficacy. So， whenever you start a program of catheter ablation for the treatment of atrial fibrillation you should be aware that your capacity to be successful is low and your potential to being harmful is high. If you are not able to add 30-60 procedures per year on top of your previous experience then you should strongly reconsider starting your program. 

  《国际循环》：您能否为我们简单介绍一下国际射频消融注册研究的设计、目的和应用?
    Cappato教授：国际射频消融注册研究是在几年前开始的，目的是尽量严密监测房颤患者导管射频消融治疗的安全性。近年来，导管射频消融治疗的应用越来越广泛，患者也对这一技术有所期望，但是我们还不知道这一技术对临床实践的确切影响。起初，大家对导管射频消融热情高涨，不过随后这一技术招致了不少批评，大家不再那么热衷于这一技术了。因此，我们认为当前的任务是尽可能地从代表日常临床实践的多个中心收集数据。我们与几位出色的心电生理学专家合作，成立了研究指导委员会，制定问卷并发放到全球的500多家中心。这一研究收集了各中心导管射频消融治疗的安全性和疗效数据，结果发现在反馈了问卷的85家开展房颤导管射频消融治疗的中心，从2003至2006年共有16，000例患者接受了这一治疗，累计治疗20，000次。治疗的成功率相当不错，达到70%，明显好于以往开展的一项研究，以往的研究收集了截止到2002年的数据，发现成功率为52%。在射频消融的基础上，加上抗心律失常药物能够使成功率进一步提升10%，以往单独用药对房颤无效。射频消融时严重并发症的发生率约为5%，新发心律失常的发生率约为8%。一些亚组分析的数据很有趣，显示如果给阵发性房颤患者实施射频消融的话，成功的可能性要较持续性房颤高43%，较永久性房颤高60%。术者经验的增加会提升成功率，每多做30例患者，成功率就会增加4%。灌注导管与常规的4 mm消融导管相比并不能增加成功率。因此，无论你何时打算开展房颤导管射频消融治疗的话，都应当意识到成功的可能性较小，失败的可能性较大。如果每年不能做上30~60例患者的话，你应当仔细考虑是不是还要开展这一项目。

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