Transcarotid echography
high‐intensity, thrombotic, Hashimoto, PV occlusion
CLOTS, HASHIMOTO, THROMBOEMBOLUS
We will use a probe and ultrasound system (FUtuRe Ultrasound HArmonic Thromboembolus Analyzer, FURUHATA, HDK‐BM001; Hashimoto Electronic Industry Co., Ltd.) that will attach to the neck and detect MESs at the carotid artery.The MES counts will be collected and evaluated separately during the different steps of the CA procedure as follows: (1) catheter manipulation and sheath flush in the right atrium; (2) transseptal puncture; (3) introducing the sheaths (SL0, Agilis, Vizigo, and/or FlexCath) into the LA; (4) introducing the CB/Achieve into the LA for CB ablation; (5) CB inflation and PV occlusion for CB ablation; (6) contrast injection to optimize the CB position for CB ablation; (7) freezing phase for CB ablation; (8) thawing phase for CB ablation; (9) CB deflation for CB ablation, Steps (4)–(9) will be repeated until achieving isolation of all four PVs; (10) obtain a 3D geometry depiction of the LA and PVs for RF ablation; (11) RF energy applications for the right PVI for RF ablation; (12) RF energy applications for the left PVI for RF ablation; and (13) induction and ablation of non‐PV triggers using isoproterenol. If a contrast injection of the entire LA is performed, MES measurements will be performed at that time as well. MESs will be divided into thrombotic debris (clots and char) as high‐intensity transient signals or microbubbles.