Navistar rmt thermocool ablation catheter

After a decapolar diagnostic catheter was positioned in the coronary sinus, and a double septal puncture was performed, a Lasso catheter was advanced into the left atrium. The 4-mm tip Navistar RMT ThermoCool ablation catheter (Biosense Webster, US) was advanced into the LA via an Agilis NxT Fr 8.5 medium curve sheath and was guided by the RMN system. Atrial mapping was performed by sweeping the Lasso catheter around the LA, reconnection of PVs was checked in redo procedures. After completion of mapping, PVI or redo-PVI was performed with the following settings: maximum radiofrequency energy application 30–50 W, with temperature limit 43 °C; and 17–30 mL/min irrigation. Substrate ablation could be performed in patients with persistent atrial fibrillation at the discretion of the operator. If substrate ablation was performed, typically a posterior box lesion set was applied in accordance with our local procedural protocol. We administered intravenous heparin for anticoagulation with a targeted ACT between 270 and 300 s. ECV was performed when indicated.

All procedures were performed using the Niobe ES RMN system (Stereotaxis, Inc, St. Louis, MO), the CARTO 3-dimensional electroanatomic mapping system (Biosense Webster Inc, Diamond Bar, CA), and the Navi-Star RMT ThermoCool ablation catheter (Biosense Webster). The Ablation History feature in the Navigant software (Stereotaxis) was used during all procedures. Ablation History provides a visual display of the history of the catheter's power output and duration of energy application at each location in the map during ablation. Based on the operator’s preference, it was allowed to use continuous dragging of the catheter while ablating rather than applying point-by-point lesions. Ablation was performed using the following RF settings: left atrial anterior wall: 50 W, flow 17 mL/min, maximum 43°C; left atrial posterior wall: 45 W, flow 17 mL/min, maximum 43°C; right ventricular outflow tract: 45–50 W, flow 20 mL/min, maximum 43°C; aortic cusp: 20 W gradually increasing to 45–50 W, flow 30 mL/min, maximum 43°C; right ventricle: 40–45 W, 20 mL/min, maximum 43°C; left ventricle: 50–55 W, 30 mL/min, maximum 43°C.