International Circulation: Could you talk about upstream drugs for atrial fibrillation such as ACE inhibitors， ARBs， statins， or anti-inflammation drugs? Do you think they are promising in preventing and treating AF?

Gerhard Hindricks :  The idea of upstream therapy in atrial fibrillation is important and is， from the approaches mentioned， promising because these upstream therapies have the potential to prevent the occurrence of atrial fibrillation and to reduce the burden of atrial fibrillation in an effective way.  There were studies published， especially in the field of ACE inhibitors and angiotensin receptor blockers (ARBs)， indicating that these pharmacological interventions may have a protective effect against atrial fibrillation.  There were significant hopes attached to these treatment concepts.  In the last couple of years however we have learned that it is not that easy.  Studies have been setup with the primary endpoint of preventing atrial fibrillation and these studies came up with less strong results or， in some cases， even failed.  My personal perspective is that there is no proof that upstream therapy will have a significant impact in the prevalence of atrial fibrillation but， looking at all data available right now， I expect there to be an effect and would promote upstream therapy strategies with ACE inhibitors and ARBs.  Data on anti-inflammatory drugs and statins are less strong but it is interesting to follow these lines of possible mechanisms to induce protection as well.