Catheter Ablation
Catheter Ablation (CA) was performed by 5 experienced electrophysiologists. Some patients underwent preprocedural imaging with cardiac computed tomographic imaging or cardiac magnetic resonance imaging while others did not. Each patient was anticoagulated without interruption or had preprocedural transesophageal echocardiogram or intracardiac echocardiogram to exclude cardiac thrombus prior to CA. All CA were assisted by 3-dimensional electroanatomic mapping with either CARTO 3v6 (Biosense Webster, Irvine, CA) or Ensite Precision (Abbott, Abbott Park, IL). Patients were placed under general anesthesia and either single or double transseptal puncture was performed with the aid of intracardiac ultrasound. Procedures utilizing CARTO mapping used the Pentaray (Biosense, Irvine, CA) mapping catheter with the Thermocool Smarttouch SF ablation catheter (Biosense, Irvine, CA). Procedures utilizing Ensite Precision used either the Reflexion Spiral or Advisor HD Grid for mapping and Tacticath ablation catheter (Abbott, Abbott Park, IL). Pulmonary vein isolation was performed with radiofrequency ablation at 30-50 W and confirmed by achieving entrance and exit block. Additional targeted ablations (caval tricuspid isthmus, posterior box, roof line, anterior mitral line and isolation of the left atrial appendage) were performed at the discretion of the performing electrophysiologist based on each subject’s unique clinical history. Focal impulse and rotor modulation mapping and ablation with a 64 pole basket catheter (Topera, Abbott, Palo Alto, CA) was also performed when deemed appropriate. Right and left atrial pressures were documented pre and post ablation. Pre ablation pressure was measured in their presenting rhythm while the post ablation pressure as measured in normal sinus rhythm. Anticoagulation was resumed post procedure for a minimum of 2 months. Antiarrhythmic drugs were stopped 5 half-lives prior to ablation in all cases except with amiodarone, which was stopped 14 days prior to ablation. Diuretics were held on the day of the procedure. Post ablation antiarrhythmics were discontinued in most cases. Accurate intake and output during the procedure and during the index hospitalization were documented. The use of bladder catheters was limited based on data describing an increased incidence of urinary complications. (20) Routine post procedure care was employed without mandating any clinical changes to patient’s care based on data obtained from the research study. Patients were followed for 30 days.