Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial

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• dc.contributor.author Falasconi, Giulio
• dc.contributor.author Penela, Diego
• dc.contributor.author Soto-Iglesias, David
• dc.contributor.author Francia, Pietro
• dc.contributor.author Saglietto, Andrea
• dc.contributor.author Turturiello, Dario
• dc.contributor.author Viveros, Daniel
• dc.contributor.author Bellido, Aldo
• dc.contributor.author Alderete, Jose
• dc.contributor.author Zaraket, Fatima
• dc.contributor.author Franco Ocaña, Paula
• dc.contributor.author Huguet, Marina
• dc.contributor.author Camara, Oscar
• dc.contributor.author Vătășescu, Radu
• dc.contributor.author Ortiz-Pérez, Jose-Tomás
• dc.contributor.author Martí-Almor, Julio
• dc.contributor.author Berruezo Sánchez, Antonio
• dc.date.accessioned 2025-10-21T05:45:52Z
• dc.date.available 2025-10-21T05:45:52Z
• dc.date.issued 2024
• dc.description.abstract Aims: Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) using very high-power short-duration (vHPSD) radiofrequency (RF) ablation proved to be safe and effective. However, vHPSD applications result in shallower lesions that might not be always transmural. Multidetector computed tomography-derived left atrial wall thickness (LAWT) maps could enable a thickness-guided switching from vHPSD to the standard-power ablation mode. The aim of this randomized trial was to compare the safety, the efficacy, and the efficiency of a LAWT-guided vHPSD PVI approach with those of the CLOSE protocol for PAF ablation (NCT04298177). Methods and results: Consecutive patients referred for first-time PAF ablation were randomized on a 1:1 basis. In the QDOT-by-LAWT arm, for LAWT ≤2.5 mm, vHPSD ablation was performed; for points with LAWT > 2.5 mm, standard-power RF ablation titrating ablation index (AI) according to the local LAWT was performed. In the CLOSE arm, LAWT information was not available to the operator; ablation was performed according to the CLOSE study settings: AI ≥400 at the posterior wall and ≥550 at the anterior wall. A total of 162 patients were included. In the QDOT-by-LAWT group, a significant reduction in procedure time (40 vs. 70 min; P < 0.001) and RF time (6.6 vs. 25.7 min; P < 0.001) was observed. No difference was observed between the groups regarding complication rate (P = 0.99) and first-pass isolation (P = 0.99). At 12-month follow-up, no significant differences occurred in atrial arrhythmia-free survival between groups (P = 0.88). Conclusion: LAWT-guided PVI combining vHPSD and standard-power ablation is not inferior to the CLOSE protocol in terms of 1-year atrial arrhythmia-free survival and demonstrated a reduction in procedural and RF times.en
• dc.format.mimetype application/pdf
• dc.identifier.citation Falasconi G, Penela D, Soto-Iglesias D, Francia P, Saglietto A, Turturiello D, et al. Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial. Europace. 2024 Mar 30;26(4):euae087. DOI: 10.1093/europace/euae087
• dc.identifier.doi http://dx.doi.org/10.1093/europace/euae087
• dc.identifier.issn 1099-5129
• dc.identifier.uri http://hdl.handle.net/10230/71595
• dc.language.iso eng
• dc.publisher Oxford University Press
• dc.relation.ispartof EP Europace. 2024 Mar 30;26(4):euae087
• dc.rights © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Paroxysmal atrial fibrillationen
• dc.subject.keyword Left atrial wall thicknessen
• dc.subject.keyword Catheter ablationen
• dc.subject.keyword Pulmonary vein isolationen
• dc.subject.keyword Multidetector cardiac tomographyen
• dc.subject.keyword Very high-power short-durationen
• dc.title Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trialen
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion