Acunav

All ablation procedures were performed under general anesthesia. Bilateral femoral access was obtained with ultrasound guidance using the modified Seldinger technique. Intravenous heparin was administered as boluses and continuous infusion to maintain a target ACT of >300 s. In both groups, esophageal temperature monitoring was performed using a commercial temperature probe (SensiTherm, Abbott). Ablation lesion delivery was halted if the esophageal temperature exceeded 39°C.
Under ICE catheter (AcuNav, Biosense Webster Inc) guidance, a transseptal puncture was made using the modified Brockenbrough technique. An 8.5 F SL1 sheath (Abbott Laboratories) was advanced into the left atrium. For cases undergoing RF‐WACA, a second transeptal puncture was performed in a similar fashion.

The right femoral vein and left median cubital vein of the forearm were used to gain vascular access. A 6 Fr 20-pole steerable catheter (BeeAT, Japan Lifeline, Tokyo, Japan), capable of recording from three sites simultaneously, was inserted through the left median cubital vein and placed into the coronary sinus, the right atrium, and the superior vena cava for pacing, recording, and internal cardioversion (23 (link)). An intracardiac echocardiography (ICE) probe (AcuNav or SoundStar, Biosense Webster, Diamond Bar, USA) was placed on the right atrial septum via the femoral vein. Transseptal access to the left atrium was established using an RF needle (Baylis Medical, Montreal, Canada) and an 8Fr or 8.5Fr long sheath (SL0, Abbott, MN, USA) under fluoroscopic and ICE guidance. During the procedure, a state of systemic anticoagulation was ensured through repetitive intravenous heparin administration to maintain an activated clotting time of 300-350 seconds. A 7Fr esophageal catheter (Esophastar, Japan Lifeline) was inserted nasally and advanced into the esophagus, posterior to the left atrium, under fluoroscopic guidance. Esophageal temperature was continuously monitored during the ablation and the application was discontinued if the temperature reached 39℃ (RF-PVI) or 15℃ (CB-PVI).