Radiofrequency ablation for AF
In patients with the combined procedure, radiofrequency ablation was performed before LAAC under conscious sedation, with fentanyl and midazolam for pain relief. Following double transseptal punctures, a left atrial (LA) anatomical map was created using a 10-pole spiral catheter (Lasso NAV; Biosense Webster, Inc., Diamond Bar, CA) under the guidance of a three-dimensional electroanatomical mapping system (CARTO 3; Biosense Webster, Inc.). A contact-force catheter (Thermocool SmartTouch; Biosense Webster, Inc.) was used to perform ablation index-guided circumferential pulmonary vein isolation with target values (450 for the anterior wall and 350 for the posterior wall). The endpoint of ablation was bidirectional conduction block between the left atrium and pulmonary veins. In patients with persistent AF, cardioversions were delivered to restore sinus rhythm after circumferential pulmonary vein isolation. Substrate modification was then performed as previously described15.