Richard Sutton， 英国著名心脏病学家，就职于圣玛丽医院，曾任Europace杂志主编（现任名誉编辑）、英国心脏起搏及心电生理学学会会长、心脏起搏欧洲工作组主席、欧洲心律学会委员会成员。

 International Circulation: Implantable cardiac defibrillator(ICD) is an effective method to prevent sudden cardiac death. Then should we implant ICD for all the patients that need cardiac resynchronization therapy (CRT) therapy?

国际循环：埋藏式心脏转复除颤器（ICD）是一种预防心源性猝死的有效方法。对于所有需要心脏再同步化治疗（CRT）的患者，我们都需要植入ICD吗？

Prof. Sutton: Yes， I believe that all patients receiving CRT should have defibrillation capacity. However， this is not in current guidelines mainly because the evidence is lacking in some sub-groups， for example， NYHA class 4. Also， the problems of defibrillators are by no means fully resolved at this point namely their high cost and their abilities to avoid inappropriate shocks.

Sutton教授：是的，我相信所有接受CRT的患者应当可以行除颤治疗。然而，目前的指南不是这样，主要是因为在一些亚组中，如NYHA心功能分级4级的患者，缺少一些证据。此外，除颤器的一些问题也未完全解决，包括其高昂的费用和避免不适当放电的能力。

International Circulation: Some previous trials， such as MADIT， MADIT II， MUSTT showed that ICD was of great significance for the primary prevention of sudden cardiac death. Then shall we implant ICD for the patients with myocardial infarction and heart failure as a routine method?

国际循环：一些以前的临床试验，例如MADIT， MADIT II， MUSTT，表明ICD对于心源性猝死一级预防有显著意义。对于心肌梗死和心力衰竭患者，我们应当将植入ICD作为一种常规方法吗？

Prof. Sutton: This is a growing area but most countries are lagging behind the US. Many of us believe that this policy results in many patients receiving complex and expensive devices which they will never use. This implies that our selection methods need to improve. Much work is currently being performed in this area. The most promising， in my view， is that by Prof Schmidt’s group in Munich， Germany involving parameters such as heart rate turbulence.

Sutton教授：这是一个发展中的领域，但大多数国家落在美国后面。许多人认为这种方法导致许多患者接受他们可能不会用到的复杂而昂贵的器械。这提示我们筛选患者的方法需要改进。在此领域目前正在进行许多研究。在我看来，最有希望的是德国慕尼黑Schmidt教授的研究，涉及了如心率震荡等参数。

International Circulation: CRT has been proved to improve symptoms and reduce mortality for heart failure patients with cardiac dyssynchrony. But some patients have a bad response to CRT. How can we improve it?

国际循环：CRT已经被证实可以改善症状，减少有心脏不同步的心力衰竭患者的死亡率。但一些患者对心脏再同步治疗反应较差，我们如何改善这种状况呢？

Prof. Sutton: This is correct and we have so far a poor understanding of non-response. I believe that we have been led in a wrong direction by many of the echo experts. We have to find other echo parameters that are easier to perform and more reproducible or to go in another direction with other forms of measurement of cardiac function.

Sutton教授：确实是这样，我们目前对无治疗反应缺乏了解。我认为我们被许多心脏超声专家带入了一个错误的方向。我们应该寻找其他更易于操作并具有可重复性的超声参数，或采用其他形式的心脏功能测量方法。