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.