Dr John M

cardiac electrophysiologist, cyclist, learner

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In AF ablation, ask tough questions about left atrial appendage isolation

September 14, 2015 By Dr John

A study presented recently at the 2015 European Society of Cardiology meeting promoted electrical isolation of the left atrial appendage as a useful strategy for the ablation of long-standing persistent AF. The study came from an influential research group. ESC increased the influence of this trial by making it a “Hot-Line” session presentation.

The BELIEF study had serious flaws. I think LAA isolation is a bad idea, a dangerous idea. I’m not alone. Professor Gerhard Hindricks from Leipzig gave a cordial but robust rebuttal of the trial after its presentation. A prominent ablation doctor in the US called me this weekend to express his concern over the promotion of this trial.

I am not saying isolation of the appendage is always a bad idea. Sometimes it happens because of ablation of other areas; sometimes a trigger of AF comes from within the appendage. In my experience, these occasions are uncommon, almost rare.

The BELIEF study considered empiric isolation of the appendage. Empiric being medical speak for doing it in all comers– or just because.

Proceeding on with extensive ablation strategies is curious because the best evidence in AF ablation favors a less-is-more approach. The STAR AF II trial shocked the EP community because it showed less ablation was superior–even in patients with advanced (persistent) AF. And whether or not you believe in rotor ablation, the concept points to focal ablation of areas of rotors rather than empiric ablation of swaths of the left atrium.

In last week’s opinion column over at theheart.org on Medscape, I wrote five reasons why I thought this was a bad idea. The link and title are here: Doubting the BELIEF Trial on LAA Isolation

JMM

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Related posts:

  1. Four commonly asked questions on AF ablation
  2. Catheter ablation of atrial fibrillation — New Trials and Fibrillation post up at theHeart.org
  3. New Trials and Fibrillations post up: Thoughts on left atrial appendage occlusion to prevent stroke in AF
  4. CW: Treating atrial fibrillation in athletes: Tough choices

Filed Under: AF ablation, Atrial fibrillation

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

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For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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