Ablate-by-LAW: CT-determined left atrial wall thickness for ablation titration in atrial fibrillation

The multicentre Ablate-by-LAW study showed that left atrial wall thickness (LAWT)-guided pulmonary vein isolation ablation is effective in both procedure time and 1-year arrhythmia-free survival rates in patients with paroxysmal atrial fibrillation. The procedure also showed a favourable safety profile.

The multicentre, international, prospective Ablate-by-LAW trial (NCT04218604) aimed to assess the safety, efficacy, and reproducibility of the LAWT-guided pulmonary vein isolation for paroxysmal atrial fibrillation ablation [1]. In this trial, presented by Dr José Fernando Alderete Martínez (Teknon Medical Centre, Catalonia, Spain), the ablation index was titrated according to the LAWT 1 mm layers, obtained using 3-dimensional maps from multidetector CT scans. All 109 participants underwent a single-catheter strategy to improve vascular safety and received general anesthesia with high-rate low-tidal volume ventilation for improved catheter stability. The primary endpoint was freedom from any documented sustained arrhythmia lasting >30 sec at the 12-month follow-up, regardless of symptoms.

The median skin-to-skin procedure time was 61.7 min (IQR 48.4–83.8), the median fluoroscopy time was 1 min (IQR 0.4–3.3), the median radiofrequency time was 13.9 min (IQR 12.3–16.8), and 86.2% of procedures were performed with single venous femoral access. The 12-month arrhythmia recurrence-free rate was 93.4% (95% CI 88.7–98.1). No differences were observed in the median procedure time, median radiofrequency time, and median fluoroscopy time across centres (P<0.05 for all), but these did not lead to differences in recurrence rates. Only 1 serious acute procedure-related complication (i.e. femoral artery pseudoaneurism) and no deaths were reported.

“The multicentre Ablate-by-LAW study demonstrated that LAWT-guided pulmonary vein isolation for paroxysmal atrial fibrillation ablation is a highly efficient procedure in terms of both procedure time, along with high 12-month arrhythmia-free survival rates and exceptionally low incidence of adverse events,” concluded Dr Alderete Martinez.

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   1. Alderete Martinez JS, et al. The multicenter ablate-by-LAW study: personalized paroxysmal atrial fibrillation ablation according to the local left atrial wall thickness. Atrial fibrillation: ablation 1. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 202430 April 2024