{"id":"d417639eb2b1","type":"article","url":"https://hartvaat.nl/2025/12/01/lawt-geleide-pvi-bij-persisterend-af-gepersonaliseerde-benadering/","title":"LAWT-geleide PVI bij persisterend AF: gepersonaliseerde benadering","title_en":"Personalized pulmonary vein isolation guided by left atrial wall thickness for persistent atrial fibrillation ablation: the PeAF-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/euaf163","source_url":"https://doi.org/10.1093/europace/euaf163","authors":["Giulio Falasconi","Diego Penela","David Soto-Iglesias","Alessia Chiara Latini","Federico Landra","Emanuele Curti","Pietro Francia","Andrea Saglietto","Dario Turturiello","Daniel Viveros","Aldo Bellido","Jose Alderete","Fatima Zaraket","Paula Franco-Ocaña","Stefano Valcher","Francesco Amata","Chiara Valeriano","Carlo Gigante","Lucio Teresi","Bruno Tonello","Roberta Mea","Lautaro Sánchez-Mollá","Carmine De Lucia","Marina Huguet","Óscar Cámara","José-Tomás Ortiz-Pérez","Julio Martí-Almor","Antonio Berruezo"],"significance":5,"published":"2025-12-01","source_date":"2025-12-01","image":"","kennis":[],"congress":"","summary_en":"The PeAF-by-LAWT trial evaluated personalised pulmonary vein isolation guided by left atrial wall thickness mapping for persistent AF. The CT-guided approach improved procedural efficiency without compromising ablation success rates.","created":"2026-07-03T10:32:02Z","updated":"2026-07-03T13:31:01Z","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":"Studie onderzocht gepersonaliseerde PVI gestuurd door linkeratriale wanddikte bij persisterend AF. De benadering verbeterde de efficiëntie zonder het succes te compromitteren.","abstract_original":"AIMS: A personalized pulmonary vein isolation (PVI) approach aimed at ablation index (AI) titration according to multidetector computed tomography-derived left atrial wall thickness (LAWT) maps reported high effectiveness and efficiency outcomes for persistent atrial fibrillation (PeAF) ablation. To date, no randomized trials have compared this approach with the standard CLOSE protocol. This non-inferiority randomized controlled trial sought to compare a LAWT-guided PVI with CLOSE protocol-based for PeAF (NCT05396534). METHODS AND RESULTS: Consecutive patients referred for first-time PeAF ablation were randomized on a 1:1 basis. In the by-LAWT arm, the AI was titrated according to local LAWT, and the ablation line was personalized to avoid the thickest regions at the pulmonary vein antrum. In the CLOSE arm, LAWT information was not available to the operator; the ablation was performed according to the CLOSE study settings: AI is ≥400 at the posterior wall and ≥550 at the anterior wall. Primary endpoint was freedom from atrial arrhythmias recurrence. Secondary endpoints were the major complication rate, procedure time, radiofrequency time, and first-pass PVI rate. One hundred fifty-six patients were included. At 12 month follow-up, no significant difference occurred in atrial arrhythmia-free survival between groups (P = 0.50). In the by-LAWT group, a significant reduction in procedure time (60.5 vs. 80.0 min; P < 0.01) and RF time (14.4 vs. 28.6 min; P < 0.01) was observed. No difference was observed regarding first-pass PVI (P = 0.72) and the major complication rate (P = 0.99). CONCLUSIONS: The PeAF-by-LAWT trial is the first prospective randomized study to demonstrate that a personalized LAWT-guided PVI for PeAF ablation is non-inferior to the standard CLOSE protocol in terms of arrhythmia-free survival while significantly improving procedural efficiency. The study was not powered to detect differences in safety outcomes."}