RFA
After performing a transseptal puncture using a one-puncture technique,
two long sheaths were inserted into the left atrium
(LA).7 A pulmonary venography was performed to
determine the anatomical relationships of the PV ostia and the LA.
Circular mapping catheters were placed in the superior or inferior PVs,
and ipsilateral PVs were circumferentially and extensively ablated under
fluoroscopic and electrophysiological guidance. RFA applications were
delivered using either an 8-mm-tip ablation catheter (Japan Lifeline
Inc, Japan), SmartTouch ThermoCool® Surround Flow irrigated-tip ablation
catheter (Biosense Webster, Irvine, CA), or TactiCath™ Quartz (Abbott,
Chicago, IL). The maximum power applied on the LA posterior wall was
20-30 W and that at the anterior aspect of the PVs was 30-40 W. The RFA
energy was delivered for 30–40 seconds at each site. When the CARTO
system (Biosense Webster, Irvine, CA) and contact force catheter were
used, RFA was delivered until the ablation index reached
>400 at the posterior wall/roof and the ablation index was
>450 at the anterior wall. A point-by-point RFA was
performed. When the EnSite system (Abbott, Chicago, IL) was used, the
lesion size index approach was conducted;8 RFA was
delivered until the lesion size index was >5 at the
posterior wall/roof and the lesion size index was >5.5 at
the anterior wall. The esophageal temperature has been routinely
measured during RFA applications to avoid esophagus-related
complications.9 In cases with an esophageal
temperature of >39℃, RFA was discontinued.