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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EPatients with long-standing persistent atrial fibrillation experienced greater rates of freedom from atrial fibrillation or atrial tachycardia, with similar rates of complications, after empirical electrical isolation of the left atrial appendage plus standard ablation compared with patients who received standard ablation only.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecatheter ablation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eleft atrial appendage\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Earrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EEmpirical electrical isolation of the left atrial appendage (LAA) for the treatment of long-standing persistent (LSP) atrial fibrillation (AF) improved freedom from AF and atrial tachycardia (AT) without increasing complications compared with standard ablation. Luigi Di Biase, MD, PhD, Albert Einstein College of Medicine, Bronx, New York, USA, presented data from the BELIEF study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01362738\u0026amp;atom=%2Fspmdc%2F15%2F28_suppl_2%2F9.2.atom\u0022\u003ENCT01362738\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELSP AF is difficult to treat with catheter ablation [Tilz RR et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E. 2012]. This is likely due to multiple origins of AF, including from the pulmonary vein and regions such as the superior vena cava, ligament of Marshall, coronary sinus, crista terminalis, left atrial posterior wall, and LAA [Di Biase L et al. \u003Cem\u003ECirculation\u003C\/em\u003E. 2010]. The purpose of this study was to determine if the empirical electrical isolation of the LAA, in addition to pulmonary vein isolation and ablation of extrapulmonary triggers, would improve freedom from AF or AT.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe BELIEF trial was a randomized, open-label, parallel-group trial with 173 patients who had LSP AF that was refractory to antiarrhythmic drugs. Patients were randomized to undergo empirical electrical isolation of the LAA plus standard ablation or standard ablation alone. The primary end point was recurrence of AF\/AT lasting \u0026gt;\u200530 seconds. The secondary end points were postablation heart failure or AF-related hospitalization, stroke, and mortality.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt baseline, the mean age was 64 years, 68% of patients had hypertension, and 20% had diabetes. The CHADS\u003Csub\u003E2\u003C\/sub\u003E score was 0 in 23.1% of patients, 1 in 35.3% of patients, and \u2265\u20052 in 41.7% of patients. The mean radiofrequency time was 93.1 and 77.4 minutes (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001) for the LAA and standard-of-care (SOC) arms, respectively. In the LAA arm, the LAA could not be isolated in 11 patients due to technical difficulty, and ablation was performed with only partial isolation. In the SOC arm, 9% of patients demonstrated sustained arrhythmia from the LAA and these patients were treated with LAA isolation.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EPatients who underwent LAA isolation experienced a significantly greater single-procedure success rate (56%) compared with patients who underwent standard ablation (28%; HR, 1.92; 95% CI, 1.3 to 2.9; log-rank \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.001) at 12 months. The cumulative overall success was 76% in the LAA arm compared with 56% in the SOC arm (HR, 2.24; 95% CI, 1.3 to 3.8; log-rank \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.003).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAt 6 months, all patients who received LAA isolation underwent transesophageal echocardiography (TEE). In 48 patients, low peak flow velocity defined as \u0026lt;\u20050.4 m\/s was detected, as well as 1 patient with a LAA thrombus and 1 patient with LAA smoke. Function was preserved in 48% of patients. There were no differences in AF and heart failure\u2013related hospitalization in the LAA isolation arm compared with the SOC arm. There were no treatment-related deaths, and 4.5% of patients in the SOC arm experienced a stroke. There were no strokes or transient ischemic attacks in the LAA arm. Periprocedural complications included pericardial effusion (1 patient in each arm) and gastrointestinal bleeding (1 in the SOC arm).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr Di Biase concluded that the results of the BELIEF trial suggest that empirical electrical isolation of the LAA in patients with LSP AF improved freedom from AF\/AT without increasing complications associated with treatment.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28_suppl_2\/9.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl7kq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}