Study limitations
The present study was limited in several ways. First, this was a
single-center, nonrandomized observational study. Second, missed brief
or silent AF episodes may have been underestimated in the present study
because of noncontinuous monitoring during the follow-up. Third, LVA
mapping in the RA could not be performed due to the long procedure.
Fourth, there may have been the possibility that the voltage mapping and
phase mapping may not have been adequately performed with sufficient
catheter contact with the atrial tissue because we did not use a contact
force sensing catheter for the mapping. Finally, we could not evaluate
the efficacy of the ablation of the high-DF sites that overlapped with
LVAs.