Flexability catheter

Under conscious sedation, the following catheters were introduced via right femoral vein: (1) a decapolar catheter (Abbott Medical, MN, USA) within the coronary sinus, (2) a 3.5‐mm open irrigated‐tip ablation catheter (Flexability catheter, Abbott Medical, MN, USA). The multielectrode catheter HD Grid was utilized (Abbott Medical; MN, USA) for EGM acquisition. Every patient had given written informed consent before the study.

Methods for PV isolation have previously been documented in the literature.
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¹⁴ During RF delivery, two 20‐polar ring catheters (Japan Lifeline Co. Ltd., Tokyo, Japan) were positioned within the ipsilateral superior and inferior PV. The irrigated RF energy was set at a target temperature of 43°C, a power cap of 30–35 W, and an infusion rate of 13 mL/min using the FlexAbility™ catheter (Abbott Japan, Tokyo, Japan). RF energy was applied for 20–30 s until the local electrogram amplitude decreased by 70%, or until double potentials were observed. The irrigated RF ablation was performed 0.5–1.0 cm away from the PV ostia, encircling the ipsilateral PV, guided by an electroanatomic mapping system (EnSite NavX™ system; Abbott, St Paul, MN, USA).
After PV isolation, additional ablation was performed as required. This included prophylactic cavotricuspid isthmus ablation, superior vena cava isolation, LA linear ablation, LA low‐voltage area ablation, and ablation of complex fractionated atrial electrograms in the right and left atria. The choice and execution of these procedures were at the discretion of the operator.