364Significance of left atrial appendage isolation in patients with long-standing persistent atrial fibrillation undergoing catheter ablation

Abstract

Background: Results from the randomized BELIEF trial showed superior success rate with empirical isolation of the left atrial appendage (LAA) compared to extensive ablation minus LAA isolation in patients with long-standing persistent AF (LSPAF) at 12 months follow-up. Objective: In the current study we sought to assess the single-procedure success rate at 5 years of follow-up in the participants of BELIEF trial. Methods: BELIEF trial enrolled 173 consenting LSPAF patients and randomly assigned them (1:1) to undergo empirical LAA isolation along with standard ablation (group 1, n=85) or standard ablation alone (group 2, n=88). Standard ablation included pulmonary vein isolation +isolation of posterior wall and superior vena cava + ablation of LA septum, roof + ablation of sustained arrhythmia from LAA and other non-PV foci detected by isoproterenol challenge. Patients were monitored for arrhythmia at office visits, ECGs, 7-day holter monitoring and event recorders. Results: Single-procedure success rate of the index procedure at 1 year was, 56% in group 1 and 28% in group 2 (log-rank p=0.001) as reported earlier in the publication. At 5 years from the index procedure, single-procedure success rate off-antiarrhythmic drugs was 43 (51%) patients in group 1 and 17 (19%) in group 2 (log-rank p=0.0002, unadjusted hazard ratio 2.01 (1.37 to 2.96]) (figure). No further thromboembolic events or other major complications were reported during the prolonged follow-up period. Conclusion: Addition of empirical isolation of LAA significantly improved the success rate of standard ablation in LSPAF patients at 5 years, without increasing complications.