In patients with long-standing persistent atrial fibrillation additional electrical isolation of the left atrial appendage (LAA) improved freedom from AF without increasing complications, reported the BELIEF study in the Hot Line session yesterday.
Several studies have shown that, in addition to pulmonary vein (PV) isolation, other non-PV areas may be the source of AF in patients, with the LAA thought to be an ‘under recognised trigger site’.according to Luigi Di Biase from Montefiore-Albert Einstein Center, New York.
In the study 173 patients with long-standing persistent AF were randomly assigned to standard treatment or standard treatment plus LAA ablation.
After one year 28% of standard treatment patients were recurrence-free compared to 56% who had had additional LAA ablation (HR 1.92; p=0.001). LAA isolation was performed in a second procedure in those not recurrence-free in either group, .
At 24 months, after an average of 1.3 procedures, the cumulative success rate was 76% for the LAA ablation group versus 56% for the standard group.There were no differences between the two groups in hospitalisation for arrhythmias or heart failure. And after adjustments, isolation of LAA in addition to standard ablation was associated with a 55% reduction in overall recurrence.
While there was no difference in complication rates between groups, mean treatment time was 93 minutes in the LAA group versus 77 minutes in the standard group.
‘The results of this randomised study show that after single and re-do procedures in patients with long-standing persistent AF, the empirical isolation of the LAA improved long-term freedom from atrial arrhythmias - without increasing complications,’ said Di Biase, adding that future studies examining the physiopathology of these findings are necessary.
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