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
PS: To read articles on Medscape, you have to register with an email. It’s free otherwise.
One reply on “In AF ablation, ask tough questions about left atrial appendage isolation”
I just finished reading your May 2014 “Exercise Over Indulgence” article and it really hit home with me. I’m 62 and have been an endurance training athlete from the age of 28 through the age of 46, running and then cycling. From 46 on I consider myself more in exercise mode without the competition but still end up from time to time in training mode putting in upwards to 9, 10, and 11 hours of cycling and other exercises a week. After multiple weeks of this I find I’ve put myself through the paces to a point of exhaustion and experience the AF until I rest and recharge. My challenge has been to find a rate and frequency of exercise and recovery time to keep me healthy without bringing me to the point of exhaustion. Yes, I’m guilty of trying to train like I did when I was competing in my 30’s and 40’s. Thank you for this article!