TY - JOUR
T1 - Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation
T2 - BELIEF Trial
AU - Di Biase, Luigi
AU - Burkhardt, J. David
AU - Mohanty, Prasant
AU - Mohanty, Sanghamitra
AU - Sanchez, Javier E.
AU - Trivedi, Chintan
AU - Güneş, Mahmut
AU - Gökoğlan, Yalçın
AU - Gianni, Carola
AU - Horton, Rodney P.
AU - Themistoclakis, Sakis
AU - Gallinghouse, G. Joseph
AU - Bailey, Shane
AU - Zagrodzky, Jason D.
AU - Hongo, Richard H.
AU - Beheiry, Salwa
AU - Santangeli, Pasquale
AU - Casella, Michela
AU - Dello Russo, Antonio
AU - Al-Ahmad, Amin
AU - Hranitzky, Patrick
AU - Lakkireddy, Dhanunjaya
AU - Tondo, Claudio
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Background Longstanding persistent (LSP) atrial fibrillation (AF) is the most challenging type of AF. In addition to pulmonary vein isolation, substrate modification and triggers ablation have been reported to improve freedom from AF in patients with LSPAF. Objectives This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. Methods This was an open-label, randomized study assessing the effectiveness of empirical electrical left atrial appendage isolation for the treatment of LSPAF. Patients were randomly assigned to undergo empirical electrical left atrial appendage isolation along with extensive ablation (group 1; n = 85) or extensive ablation alone (group 2; n = 88). Recurrence of atrial arrhythmias was the primary endpoint. Secondary endpoints included cardiac-related hospitalization, all-cause mortality, and stroke at follow-up. Results Major clinical characteristics were not different between the 2 groups. At 12-month follow-up, 48 (56%) patients in group 1 and 25 (28%) in group 2 were recurrence free after a single procedure (unadjusted hazard ratio [HR] for recurrence with standard ablation: 1.92; 95% confidence interval [CI]: 1.3 to 2.9; log-rank p = 0.001). After adjusting for age, sex, and left atrial size, standard ablation was predictive of recurrence (HR: 2.22; 95% CI: 1.29 to 3.81; p = 0.004). During repeat procedures, empirical electrical left atrial appendage isolation was performed in all patients. After an average of 1.3 procedures, cumulative success at 24-month follow-up was reported in 65 (76%) in group 1 and in 49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; log-rank p = 0.003). Conclusions This randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications.
AB - Background Longstanding persistent (LSP) atrial fibrillation (AF) is the most challenging type of AF. In addition to pulmonary vein isolation, substrate modification and triggers ablation have been reported to improve freedom from AF in patients with LSPAF. Objectives This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. Methods This was an open-label, randomized study assessing the effectiveness of empirical electrical left atrial appendage isolation for the treatment of LSPAF. Patients were randomly assigned to undergo empirical electrical left atrial appendage isolation along with extensive ablation (group 1; n = 85) or extensive ablation alone (group 2; n = 88). Recurrence of atrial arrhythmias was the primary endpoint. Secondary endpoints included cardiac-related hospitalization, all-cause mortality, and stroke at follow-up. Results Major clinical characteristics were not different between the 2 groups. At 12-month follow-up, 48 (56%) patients in group 1 and 25 (28%) in group 2 were recurrence free after a single procedure (unadjusted hazard ratio [HR] for recurrence with standard ablation: 1.92; 95% confidence interval [CI]: 1.3 to 2.9; log-rank p = 0.001). After adjusting for age, sex, and left atrial size, standard ablation was predictive of recurrence (HR: 2.22; 95% CI: 1.29 to 3.81; p = 0.004). During repeat procedures, empirical electrical left atrial appendage isolation was performed in all patients. After an average of 1.3 procedures, cumulative success at 24-month follow-up was reported in 65 (76%) in group 1 and in 49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; log-rank p = 0.003). Conclusions This randomized study showed that both after a single procedure and after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications.
KW - arrhythmia
KW - atrial fibrillation
KW - non-PV trigger
KW - pulmonary vein
KW - radiofrequency
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U2 - 10.1016/j.jacc.2016.07.770
DO - 10.1016/j.jacc.2016.07.770
M3 - Article
C2 - 27788847
AN - SCOPUS:85018410534
SN - 0735-1097
VL - 68
SP - 1929
EP - 1940
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -