IC: How do you feel about the new anticoagulant and anti-arrhythmic agents? Will they change the positions of rhythm and rate control in AF therapy?
　　《国际循环》：您觉得新型抗凝剂和抗心律失常药物代理商怎样想？在房颤治疗策略选择中他们会改变节律和心率控制的立场吗？
　　Dr. Valderrabano: There is no doubt that NOAC have made a difference. They are an advance. The main obstacle is their cost. They also have certain issues， such as reversing the anticoagulant effect. If you have bleeding issues， you cannot reverse dabigatran easily， you have to wait until the drug is metabolized. They have certain problems， but there is definitely in improvement compared to warfarin in that provide a good， continuous level of anticoagulation with a fixed dose. That is a huge improvement.
　　I am thoroughly pessimistic about your question on anti-arrhythmic therapy. We have not had any good drug. We were happy with dronedarone three years ago. Then the PALLAS study came out showing that it was just another drug that kills people. There have been multiple approaches to developing the right drug. We do not know how these drugs work. The ones that seem to be more effective at preventing arrhythmias， such amiodarone， are also more toxic. Dronedarone is not as toxic， but if you give it to the wrong patients， it may kill them. The same happens to all the old anti-arrhythmic drugs， the class IC and III. These are poisonous， but have a good effect in some patients. They are all based on a very crude understanding of the pathophysiology. We block channels and hope they work. We are not giving a therapy based on the understanding of the disease.
　　Valderrabano博士：毫无疑问，NOAC（新型口服抗凝剂）带来了进步。主要障碍是价格成本，也有其他的问题，比如拮抗抗凝作用。如果患者发生出血，我们无法拮抗药物的抗凝作用，只能等待，直到药物代谢掉。虽然有一定的问题，但这相对华法令来说绝对是在改进，使用固定剂量提供良好的、持续稳定的抗凝治疗。这是一个巨大的进步。
　　我对于抗心律失常治疗的问题彻底悲观，因为没有得到很好的药物。3年前我们对于决奈达隆的出现感到欢欣鼓舞，但是PALLAS研究证明这只是另一个能“杀人”的药物。有多种方法用于发展正确的药物，但我们不知道这些药物的作用机制。那些似乎能更有效的预防心律失常的药物如胺碘酮，也更有毒性。决奈达隆并没有这样的毒性，但如果选择错误的患者并令其服用，将有可能杀死他们。所有的老牌抗心律失常药物也都是这样，如经典的IC类和III类抗心律失常药，这些药物都是有毒性的，但是在某些患者身上使用可以有好的效果。使用抗心律失常药物必须基于非常严格的病理生理学理解，怎样阻滞或者激活离子通道使其发挥作用，而不是基于对于疾病的了解。

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