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Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial

Journal of the American College of Cardiology, 2016-11, Vol.68 (18), p.1929-1940 [Peer Reviewed Journal]

Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Nov 1, 2016 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2016.07.770 ;PMID: 27788847

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Title:
Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial
Author: Di Biase, Luigi ; Burkhardt, J David ; Mohanty, Prasant ; Mohanty, Sanghamitra ; Sanchez, Javier E ; Trivedi, Chintan ; Güneş, Mahmut ; Gökoğlan, Yalçın ; Gianni, Carola ; Horton, Rodney P ; Themistoclakis, Sakis ; Gallinghouse, G Joseph ; Bailey, Shane ; Zagrodzky, Jason D ; Hongo, Richard H ; Beheiry, Salwa ; Santangeli, Pasquale ; Casella, Michela ; Dello Russo, Antonio ; Al-Ahmad, Amin ; Hranitzky, Patrick ; Lakkireddy, Dhanunjaya ; Tondo, Claudio ; Natale, Andrea
Subjects: Aged ; Anticoagulants ; Atrial Appendage ; Atrial Fibrillation - surgery ; Cardiac arrhythmia ; Cardiac Surgical Procedures - methods ; Cardiovascular disease ; Catheter Ablation ; Catheters ; Diabetes ; Electrophysiologic Techniques, Cardiac ; Female ; Heart failure ; Humans ; Hypertension ; Male ; Middle Aged ; Patients ; Performance evaluation ; Recurrence ; Time Factors
Is Part Of: Journal of the American College of Cardiology, 2016-11, Vol.68 (18), p.1929-1940
Description: 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. This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. 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. 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). 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. (Effect of Empirical Left Atrial Appendage Isolation on Long-term Procedure Outcome in Patients With Persistent or Longstanding Persistent Atrial Fibrillation Undergoing Catheter Ablation [BELIEF]; NCT01362738).
Publisher: United States: Elsevier Limited
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2016.07.770
PMID: 27788847
Source: Geneva Foundation Free Medical Journals at publisher websites
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Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial

Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Nov 1, 2016 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2016.07.770 ;PMID: 27788847

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