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.