Daig sl1

In contrast to the phased RF ablation groups, access to the left atrium (LA) was achieved by performing two separate transseptal punctures (TSP). A non-steerable sheath (Daig SL1; St. Jude Medical, St. Paul, Minnesota, USA) for advancing the diagnostic circular decapolar catheter (Inquiry Optima; St. Jude Medical), and a deflectable long sheath (Agilis; St. Jude Medical) for the ablation catheter were placed in the LA. Management of anticoagulation including ACT measurements and heparin dosage were identical with the phased RF groups. After selective, simultaneous angiography of the ipsilateral PVs and acquisition of the individual three-dimensional anatomy of the LA (Ensite NavX Velocity; St. Jude Medical, with image integration), antral circumferential RF ablation around ipsilateral PVs using a 4 mm open-tip irrigated catheter (IBI Therapy Coolpath Duo; St. Jude Medical) was performed. Maximum power was set to 30W, going selectively up to 40W if PVI could not be achieved, especially at the anterior ridge border of the lateral PVs. Temperature was limited to 43°C. Irrigation was adjusted manually between 17 and 30 mL/min. Electrical cardioversion was performed if the patient remained in AF after PVI.