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

Luigi Di Biase, J. David Burkhardt, Prasant Mohanty, Sanghamitra Mohanty, Javier E Sanchez, Chintan Trivedi, Mahmut Güneş, Yalçın Gökoğlan, Carola Gianni, Rodney P Horton, Sakis Themistoclakis, Joseph G. Gallinghouse, Shane Bailey, Jason D Zagrodzky, Richard H Hongo, Salwa Beheiry, Pasquale Santangeli, Michela Casella, Antonio Dello Russo, Amin Al-AhmadPatrick Hranitzky, Dhanunjaya Lakkireddy, Claudio Tondo, Andrea Natale

Research output: Contribution to journalArticle

Abstract

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. (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).

Original languageEnglish
Pages (from-to)1929-1940
Number of pages12
JournalJournal of the American College of Cardiology
Volume68
Issue number18
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Atrial Appendage
Catheter Ablation
Atrial Fibrillation
Recurrence
Confidence Intervals
Cardiac Arrhythmias
Pulmonary Veins
Hospitalization
Stroke
Mortality

Keywords

  • Journal Article

Cite this

Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation : BELIEF Trial. / 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, Joseph G.; 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.

In: Journal of the American College of Cardiology, Vol. 68, No. 18, 01.11.2016, p. 1929-1940.

Research output: Contribution to journalArticle

Di Biase, L, Burkhardt, JD, Mohanty, P, Mohanty, S, Sanchez, JE, Trivedi, C, Güneş, M, Gökoğlan, Y, Gianni, C, Horton, RP, Themistoclakis, S, Gallinghouse, JG, Bailey, S, Zagrodzky, JD, Hongo, RH, Beheiry, S, Santangeli, P, Casella, M, Dello Russo, A, Al-Ahmad, A, Hranitzky, P, Lakkireddy, D, Tondo, C & Natale, A 2016, 'Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial', Journal of the American College of Cardiology, vol. 68, no. 18, pp. 1929-1940. https://doi.org/10.1016/j.jacc.2016.07.770
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, Joseph G. ; 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. / Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation : BELIEF Trial. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 18. pp. 1929-1940.
@article{7a69220ee31343b8b98ba12fe7f39011,
title = "Left Atrial Appendage Isolation in Patients With Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial",
abstract = "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. (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).",
keywords = "Journal Article",
author = "{Di Biase}, Luigi and Burkhardt, {J. David} and Prasant Mohanty and Sanghamitra Mohanty and Sanchez, {Javier E} and Chintan Trivedi and Mahmut G{\"u}neş and Yal{\cc}ın G{\"o}koğlan and Carola Gianni and Horton, {Rodney P} and Sakis Themistoclakis and Gallinghouse, {Joseph G.} and Shane Bailey and Zagrodzky, {Jason D} and Hongo, {Richard H} and Salwa Beheiry and Pasquale Santangeli and Michela Casella and {Dello Russo}, Antonio and Amin Al-Ahmad and Patrick Hranitzky and Dhanunjaya Lakkireddy and Claudio Tondo and Andrea Natale",
note = "Copyright {\circledC} 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.jacc.2016.07.770",
language = "English",
volume = "68",
pages = "1929--1940",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "18",

}

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, Joseph G.

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 - Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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. (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).

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. (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).

KW - Journal Article

U2 - 10.1016/j.jacc.2016.07.770

DO - 10.1016/j.jacc.2016.07.770

M3 - Article

C2 - 27788847

VL - 68

SP - 1929

EP - 1940

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 18

ER -