2.3 Ablation procedure
The protocol for RFCA in our institution is described in the previous
studies.19,
20 In brief, double trans-septal
punctures were performed after positioning multi-polar catheters at the
right ventricle, high right atrium, and coronary sinus. The EnSite
NavX/Velocity (St. Jude Medical, St. Paul, MN) or CARTO (Biosense
Webster, Irvine, CA) system were used for three-dimensional
electroanatomic mapping. In patients with paroxysmal AF, the endpoint of
the procedure was the elimination of all trigger focus. If non-pulmonary
vein trigger was present after successful pulmonary vein isolation,
additional ablation was performed to eliminate non-pulmonary vein
trigger. Additional substrate modification was performed if the operator
considered non-inducibility is more important than trigger point
elimination. In non-paroxysmal AF, AF was induced by rapid atrial pacing
after pulmonary vein isolation. The procedure was finished if sustained
AF (lasting for more than five minutes) was not induced. Additional
ablation such as complex fractionated atrial electrogram guided
ablation, linear ablation, or low-voltage zone ablation were performed
at the operator’s discretion if sustained AF was induced after pulmonary
vein isolation.