Procedural management
All patients received oral anticoagulants prior to the procedure. In patients taking direct oral anticoagulants, the drugs were interrupted on the day of the procedure and re-administered on the next morning after the procedure. In patients taking warfarin, the warfarin therapy was continued without interruption.
During the procedure, a single transseptal puncture was performed with an RF needle (Baylis Medical Inc, Montreal, Quebec, Canada) and 8 Fr long sheath (SL0, Abbott, Minneapolis, MN). Five thousand U of Heparin was administered before the transseptal puncture and additionally given to maintain an activated clotting time between 300 and 350 seconds. After the transseptal puncture, an 8 Fr long sheath was exchanged for a steerable 15 Fr sheath (Flexcath Advance, Medtronic, Minneapolis, MN).