2.6 Radiofrequency ablation for atrial fibrillation
In patients with combined procedures, radiofrequency ablation was performed prior to LAAC. An additional decapolar catheter was placed in the coronary vein through the left femoral vein access in patients with combined procedure. In ICE group, ICE was used to create a LA anatomical map in the right atrium. Single transseptal puncture was guided by ICE. An ablation catheter (Thermocool SmartTouch, Biosense Webster, Inc) supported by a steerable sheath (Agilis NXT; St. Jude Medical, St Paul, MN, USA) was used to perform ablation index guided circumferential pulmonary vein isolation. In patients with persistent atrial fibrillation, cardioversions were delivered to restore sinus rhythm after CPVI. Substrate mapping and ablation then was performed as previously described7. In TEE group, following double transseptal punctures, the LA anatomical map was created using a 10-pole spiral catheter (Lasso NAV, Biosense Webster, Inc.) under Carto3 mapping system guidance. The ablation strategy was similar in the ICE group.