Cather ablation procedures
The radiofrequency catheter ablation (RFCA) procedures were performed
under conscious sedation. The detail of the procedure has been described
previously13. After access to the left atrium (LA) via
the transseptal puncture needle (Synaptic Medical), two 8.5 - French
sheaths (NaviEase, Synaptic Medical) were advanced into LA. Intravenous
heparin was administered immediately after the transseptal puncture and
to maintain the activated clotting time of 250 - 350 seconds throughout
the procedure. A 7-French mapping catheter (PentaRay, Biosense Webster)
was used to perform the 3-dimensional electrical anatomical mapping
(EAM) under the guidance of the CARTO3 system (Biosense Webster). An
8-French 3.5-mm tip irrigated ablation catheter (SmartTouch, Biosense
Webster) with an upper power of 40 W, an upper temperature limit of
43°C, and a flow rate of 17 mL/min was used to perform the catheter
ablation. The stepwise ablation strategy was employed: i)
circumferential pulmonary vein isolation (CPVI) with bi-directional
electric block as the endpoint in every patient; ii) if AF remained
after CPVI, the complex fractionated atrial electrogram (CFAE) based
ablation was performed; iii) if focal or reentrant atrial tachycardia
(AT) was presented during the procedure, a focal or linear ablation
based on the EAM and/or entrained mapping was performed; iv) if
cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) was observed
before or during the procedure, linear ablation of the CTI was performed
with di-directional conduction block as the endpoint; v) if AF persisted
after all these ablation lesions, intravenous ibutilide and/or electric
cardioversion was used to restore sinus rhythm. The detailed ablation
data in catheter ablation group is shown in Table S1.