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.