Personalised LAWT-guided ablation non-inferior to CLOSE protocol for paroxysmal atrial fibrillation

A personalised approach using left atrial wall thickness (LAWT)-guided very high-power short-duration (VHPSD) alternating with a radiofrequency protocol was non-inferior to a CLOSE protocol in reducing arrhythmia recurrence in patients with paroxysmal atrial fibrillation.

QDOT-by-LAW (NCT04298177) was a single-centre, prospective, randomised trial [1]. The 162 participants were randomised 1:1 to either a personalised pulmonary vein isolation ablation by a CT-assessed, LAWT-guided VHPSD alternating with a radiofrequency protocol or to a CLOSE protocol. Participants were excluded if they had a previous ablation procedure or if they had a contraindication to the pre-procedural CT scan. The primary endpoint was freedom from any documented atrial fibrillation at a minimum of 12 months of follow-up after a single ablation procedure, while secondary endpoints included procedure time, radiofrequency time, fluoroscopy time, and first-pass pulmonary vein isolation rate.

Assessment of the primary endpoint showed no difference in arrhythmia-free survival between the 2 treatment arms, with rates of 85% at 12 months in both groups (P=0.88). However, the LAWT-guided protocol led to decreased skin-to-skin procedure time (P<0.001), fluoroscopy time (P=0.01), fluoroscopy dose (P=0.02), and total radiofrequency time (P<0.001). Furthermore, no differences were seen between treatment arms in terms of first-pass isolation rates for both the left and right pulmonary veins (P=0.99). It should be noted that no safety information was reported during the presentation.

“QDOT-by-LAWT demonstrates that a LAWT-guided personalised pulmonary vein isolation approach and standard power ablation modes for paroxysmal atrial fibrillation ablation is not inferior to the CLOSE protocol in terms of arrhythmia-free survival at 12 months,” concluded Dr Diego Penela (Medical Centre Teknon, Catalonia, Spain), while the approach “enhances efficacy by a reduction in procedural, fluoroscopy, and radiofrequency times.”

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   1. Falasconi G, 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. Late-Breaking Science: ablation. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202430 April 2024