Study subjects
The present study was designed as a prospective cross-sectional study
and performed in accordance with the tenets of the Declaration of
Helsinki. The study protocol was approved by the Institutional Review
Board of the Shizuoka Medical Center (approval number: 2019-R32).
Written informed consent was obtained from all participants before
participation. We recruited 41 patients with highly symptomatic
paroxysmal or persistent AF refractory to medical management for
circumferential PV isolation between October 2019 and March 2020. The
exclusion criteria included previous PV isolation, age <18
years, and inability to provide informed consent. Patients who had a
history of open-heart surgery were excluded because it could affect ECs.
Moreover, patients with an implanted pacemaker were excluded due to
difficulties in performing computed tomography image analysis resulting
from artifact from the pacemaker leads.
All antiarrhythmic drugs except for amiodarone were discontinued for at
least 5 half-lives before the procedure. Amiodarone was discontinued 4
weeks in advance.