Procedural workflow
Procedures were generally performed in conscious sedation, except in
pediatric patients (< 14 years) and patients undergoing hybrid
procedure for AF who received general anesthesia. Bilateral femoral vein
punctures were performed to access the heart. All procedures were
performed with 3D EAM system (NavX™; Abbott, IL, USA or Carto®; Biosense
Webster, CA, USA) and ICE (Acunav™; Biosense Webster, CA, USA). All
parts of the procedures were performed completely without the use of
fluoroscopy, including mapping and ablation.
All patients received a full therapeutic dose of heparin before TSP and
majority of AF patients had an uninterrupted anticoagulation strategy.
Activated clotting time was regularly checked after having achieved
transseptal access with a target of at least 300 seconds. The SR0™ or
SL1™ long sheaths with dilators (Abbott, IL, USA) and HeartSpan®
transseptal needle (71cm, 50% curve, 21 Gauge; MeritMedical, Utah, USA)
were typically used for TSP. In case of the “RF needle” technique a
full metal BRK™ transseptal needle (71 cm, 50% curve, 18 Gauge; Abbott,
IL, USA) was used.