Falasconi, GiulioPenela, DiegoSoto-Iglesias, DavidFrancia, PietroSaglietto, AndreaTurturiello, DarioViveros, DanielBellido, AldoAlderete, JoseZaraket, FatimaFranco Ocaña, PaulaHuguet, MarinaCamara, OscarVătășescu, RaduOrtiz-Pérez, Jose-TomásMartí-Almor, JulioBerruezo Sánchez, Antonio2025-10-212025-10-212024Falasconi 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/euae0871099-5129http://hdl.handle.net/10230/71595Aims: 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.application/pdfeng© 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.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1093/europace/euae087Paroxysmal atrial fibrillationLeft atrial wall thicknessCatheter ablationPulmonary vein isolationMultidetector cardiac tomographyVery high-power short-durationinfo:eu-repo/semantics/openAccess