Procedure
Catheter ablation of AF (AFCA) and LAAC were performed via femoral venous access under local anesthesia, and heparin was used to achieve a target activated coagulation time of >250s. Every patient accepted AFCA firstly and then followed with Watchman LAAC closure.
Under conscious sedation, a decapolar catheter was positioned in the coronary sinus and two transseptal accesses were obtained through right femoral vein. Mapping and ablation were performed under the guidance of CARTO (Biosense Webster, Diamond Bar, CA, USA) or Ensite (St. Jude Medical, St Paul, MN, USA) 3-dimensional electroanatomic mapping systems in addition to standard fluoroscopy. For patients with paroxysmal AF, standard pulmonary vein isolation (PVI) was performed and for those with persistent AF, additional linear and/or complex fragmented atrial electrogram ablations were performed according to the physician’s discretion. Sinus rhythm was restored by either ablation or electric cardioversion.
LAAC procedure was under local anesthesia and TEE was introduced under deep sedation after device deployment to reconfirm the position of the device before release. The orifice diameter and depth of the LAA were measured by TEE. A mean left atrial pressure above 10 mmHg was obtained before measurement. Only WATCHMANTM (Boston Scientific, MA, USA) devices were used. The device with appropriate size was chosen when the depth was allowed, generally 4-6 mm larger the maximum diameter measured by TEE. The device was then advanced into the delivery sheath and deployed by sheath retraction guided by fluoroscopy. Preliminary assessment was performed by angiography and tug test under fluoroscopy to check the device position and stability. TEE was then performed to reconfirm the position with minimal (<5 mm) to no PDL. The device was released if it was verified by the assessment of PASS criteria. The specific details were described as our previous essay[5]. Each patient received OAC therapy during follow-up.