Ablation procedure
Anti-arrhythmic drugs (AADs) were discontinued for at least five
half-lives prior to ablation. Oral anticoagulant drugs were skipped just
before the procedure. EnSite NavxTM (Abbott, St Paul,
MN, USA) was used to perform all ablation procedures. The ablation
strategy consisted of liner ablations, including the roof, bottom, and
MI, as well as pulmonary vein (PV) and superior vena cava (SVC)
isolation under general anesthesia. The CS was cannulated using a
guiding catheter (CPS AimTM SL; Abbott) via an
approach from the internal jugular vein. Subsequently, a contrast agent
was injected through BermanTM angiographic catheter
(Teleflex, Morrisville, NC, USA) while a balloon was being inflated
(Figure 2A). If angiography adequately confirmed the VOM, then EIVOM was
performed in advance of RF ablation.
In both groups, an irrigation catheter (FlexiAbilityTMor TactiCathTM; Abbott) was used to deliver RF pulses
(30 W, 40 s) point-by-point at the endocardium of the lateral MI under
left atrial appendage (LAA) pacing (Figure 2E). The ablation catheter
was supported by steerable introducer (AgilisTM NxT
steerable introducer; Abbott) to gain adequate contact force and
stability. If a bidirectional block line was not fully achieved,
additional RF pulses (25 W, 30 s) via approaches from the femoral and
internal jugular veins were delivered to the inside of the CS, which was
opposite the endocardial MI line. (Figure 2F & G) Bidirectional block
was confirmed by a differential pacing maneuver from the distal and
proximal CS sites.