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 LAA isolation for the treatment of LSPAF. Patients were randomly assigned to undergo empirical electrical LAA 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 two groups.
At 12-month follow-up:
● 48 (56%) patients in group 1 vs 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; 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 LAA isolation was performed in all patients.
At the 24-month follow-up:
● After an average of 1.3 procedures, cumulative success was:
● 65 (76%) in group 1 and in 49 (56%) in group 2 (unadjusted HR: 2.24; 95% CI: 1.3 to 3.8; p = 0.003)
Conclusion
This study showed that after a single procedure, as well as after redo procedures in patients with LSPAF, empirical electrical isolation of the LAA improved long-term freedom from atrial arrhythmias without increasing complications.
Di Biase L, Burkhardt JD, Mohanty P, Mohanty S, Sanchez JE, Trivedi C, Gunes M, Gokoglan Y, Gianni C, Horton RP, Themistoclakis S, Gallinghouse GJ, Bailey S, Zagrodzky JD, Hongo RH, Beheiry S, Santangeli P, Casella M, Dello Russo A, Al-Ahmad A, Hranitzky P, Lakkireddy D, Tondo C and Natale A. Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial. Journal of the American College of Cardiology. 2016;68:1929-1940. NCT01362738.
View Article on Pubmed