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.