Electrophysiology Study and Ablation
Data collection and analysis were performed according to protocols approved by the NYU Langone Health Institutional Review Board. Surface and intracardiac electrograms were digitally recorded and stored (EP Workmate, Abbott Medical, Inc.,). Non-fluoroscopic 3-dimensional mapping was performed using the Carto 3 (Biosense-Webster, Inc.,) mapping system.
All procedures were performed under general anesthesia with high frequency jet ventilation. A 7-French 20-pole catheter (Daig DuoDeca 2-10-2, Abbott Medical, Inc.) was used with the distal poles placed within the coronary sinus and the proximal electrodes located along the tricuspid annulus in the lateral and inferior right atrium. For left atrial mapping and recording, a 10- or 20-pole circumferential PV mapping catheter (Lasso, Biosense-Webster, Inc.), or a five-spline mapping catheter (PentaRay Nav, Biosense-Webster, Inc.) was utilized. Left atrial three-dimensional anatomy and voltage mapping was created with manipulation of the multi-electrode mapping catheter. Ablation was performed in each group with an open-irrigated, 3.5-mm RFA catheter (Thermocool SMARTTOUCH SF, Biosense Webster Inc.). Ablation lesions were generated in a power-controlled mode applying 35 to 50 W for 6 to 30 seconds per lesion during irrigation at a rate of 8 to 15-mL/min while maintaining a goal ACT of > 350 seconds. A waiting period of 30 minutes, followed by administration of adenosine, was utilized to confirm pulmonary venous entrance and exit block. A major complication is a complication that results in permanent injury or death, requires intervention for treatment, or prolongs or requires hospitalization for more than 48 hours9. All patients received in-person or telehealth post-procedure follow-up 10 to 20 days after discharge, and all patient charts were reviewed 30 days after discharge.