International Circulation: Will it drop below amiodarone or be removed completely?
　　《国际循环》：决奈达隆的地位会下降甚至低于胺碘酮，还是会在指南中被完全除名呢？
　　Dr Vardas: Actually it will be emphasized that dronedarone cannot be used in patients with heart failure or in patients with chronic atrial fibrillation. Of course， I have to confess something else. Even in the existing guidelines we do not suggest using dronedarone in patients with heart failure and we don’t suggest using dronedarone in patients with chronic atrial fibrillation. In fact we say the opposite. We say that dronedarone should not be used in patients with heart failure but again after the new findings of the PALLAS trial， we are going to publish a new updated report. Indeed， I cannot say what the new report will say as we have not commenced writing it so it is risky to say that in the new report dronedarone is going to lose its position. What I can officially announce here is that we are thinking to publish a new report very soon where we are going to re-evaluate the role of dronedarone in the guidelines. Finally， the new guidelines include ablation. Despite the expectations of many， because in writing the guidelines we did not have many large trials to support ablation as a first choice， ablation remains as a Class IIa indication for patients with symptomatic atrial fibrillation and normal heart function. Recently， the American Guidelines have classified the same category of patients as a Class I indication; we remain as Class IIa. We suggest these patients are treated first with drugs and if drugs fail then go to ablation. Of course， in individual cases you can prioritize ablation before the drugs with this category of patients (symptomatic， very young and with normal hearts). But officially the guidelines indicate that for patients with symptomatic atrial fibrillation and more-or-less normal hearts， ablation of the pulmonary veins as a Class IIa indication.
　　Vardas：指南强调决奈达隆不能在心力衰竭或慢性房颤的患者中使用。当然，我不得不承认即使在现有的准则下，不建议在心力衰竭及慢性房颤患者中使用决奈达隆。事实上，我们说的相反，我们说决奈达隆不应该应用于心力衰竭的病人，但仍发布了PALLAS试验新的研究结果。事实上，在开始制定新的指南之前，我不能说决奈达隆是有风险的说或是将失去它的地位，而只能正式宣布，我们将重新评估决奈达隆在指南中的地位，并公布新的报告。最后，新准则还包括射频消融相关的内容。尽管有许多的期望，但因为在制定指南的时候仍没有大型的试验支持消融作为首选治疗，所以目前消融治疗仍然是症状性房颤患者和心功能正常患者的IIa类治疗。近期的美国相关指南，将同类患者作为I类治疗，但我们还是保持IIa类，我们建议这些患者先用药物治疗，如果失败则可进一步选择消融。当然，在个别情况下可以优先选择消融治疗（症状性房颤患者、年轻、心功能正常）。但正式的指南表明，对于有症状的房颤和心功能基本正常的患者，肺静脉消融仍作为IIa类指征。
　　International Circulation: What is your opinion of the HAS-BLED score and the CHA2DS2-VASc score from your personal clinical experience?
　　《国际循环》：您对HAS-BLED及CHA2DS2 VASC评分标准怎样看？
　　Dr Vardas: They are very important scores to keep your rationale under certain rules.
　　Vardas：这些评分标准对于在一定准则下保持自己的临床意向是非常重要的。

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