2.2 | Procedure
Anticoagulation therapy was initiated at least 3 weeks before the procedure. An electrophysiological study and ablation procedure were conducted under conscious sedation with fentanyl and midazolam. A 6 French decapolar catheter (Promapper Nav; Jinjiang Electronic Medical Device Technology Co., Ltd, Sichuan, China) was positioned in the coronary sinus (CS). Operators performed transseptal puncture and introduced an 8.5 French long sheath (SL1; St. Jude Medical) into the left atrium (LA) over a guidewire under the guidance of fluoroscopy and intracardiac echocardiography (Cartosound, Biosense Webster Inc.). Continuous heparinized saline flush (20 ml/h) was maintained through the transseptal sheath, and heparin was administered to maintain activated clotting time (ACT) >300s throughout the procedure, with monitoring every 30 minutes.
The LEAD-PFA system (Jinjiang Electronic Medical Device Technology Co., Ltd, Sichuan, China) employed in our study integrates the PFA system and a cardiac 3-dimensional electroanatomic mapping system (LEAD-Mapping, Jinjiang Electronic Medical Device Technology Co., Ltd, Sichuan, China) for magnetic navigation, localization, mapping, and ablation. LA and pulmonary vein (PV) were reconstructed under the guidance of that 3-dimensional electroanatomic mapping system using a circular PFA catheter (Jinjiang Electronic Medical Device Technology Co., Ltd, Sichuan, China) (Figure 2A ). The PVI and LAPW ablation were performed with the circular PFA catheter. Each application consisted of 4 biphasic pulse trains lasting 200 ms at 1800 V. The circular PFA catheter was positioned at each pulmonary vein ostium. After each application, the catheter was rotated circumferentially to a new position to achieve full circumferential isolation. After PVI, LAPW was then ablated with the circular PFA catheter. CTI and MI ablation were performed with a focal contact force PFA catheter (Jinjiang Electronic Medical Device Technology Co., Ltd, Sichuan, China) (Figure 2B ). Each point-by-point application consisted of 4 biphasic pulse trains lasting to 200 ms at 1800 V. If AF persisted after these steps, electrical cardioversion would be performed to restore sinus rhythm. If an organized AFL occurred during the procedure, mapping-guided ablation would be performed.