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.
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