{"id":"eb0382c8d2e7","type":"article","url":"https://hartvaat.nl/2024/03/30/qdot-by-lawt-gepersonaliseerde-pvi-gestuurd-door-linkeratriale-wanddikte/","title":"QDOT-by-LAWT: gepersonaliseerde PVI gestuurd door linkeratriale wanddikte","title_en":"Personalized pulmonary vein isolation with very high-power short-duration lesions guided by left atrial wall thickness: the QDOT-by-LAWT randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euae087","source_url":"https://doi.org/10.1093/europace/euae087","authors":["Giulio Falasconi","Diego Penela","David Soto-Iglesias","Pietro Francia","Andrea Saglietto","Dario Turturiello","Daniel Viveros","Aldo Bellido","Jose Alderete","Fatima Zaraket","Paula Franco-Ocaña","Marina Huguet","Óscar Cámara","Radu Vătășescu","José-Tomás Ortiz-Pérez","Julio Martí-Almor","Antonio Berruezo"],"significance":6,"published":"2024-03-30","source_date":"2024-03-30","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested whether personalizing RF ablation energy delivery based on left atrial wall thickness improves pulmonary vein isolation outcomes for paroxysmal AF.","created":"2026-07-03T10:30:50Z","updated":"2026-07-03T13:29:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial onderzocht of personalisatie van RF-energie op basis van linkeratriale wanddikte de PVI-uitkomsten verbetert. De gepersonaliseerde benadering was non-inferieur met potentieel veiliger energietoediening.","abstract_original":"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."}