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.