Cardiac catheterization
All patients underwent the catheter ablation procedure in the fasting
state under local anesthesia and conscious sedation with dexmedetomidine
hydrochloride and thiamylal sodium. Respiratory management devices
including nasal airway device and adaptive servo-ventilation were used
at the operator’s discretion. A 6Fr, double-decapolar, steerable
catheter (BeeAT, Japan Lifeline Co, Tokyo, Japan) was inserted into the
coronary sinus via the right internal jugular vein. An 8 Fr Carto
SoundStar® was inserted into the right atrium via the
right femoral vein, and the LA 3-dimensional (3D) geometry was created
by CartoMergeTM module equipped in a Carto3 system
(Biosense Webstar) which was thereafter integrated with the 3D LA CT
image which was taken approximately one week before the study. After the
transseptal puncture done under the ICE guidance, we inserted two 8.5Fr
long sheaths (SL0; St Jude Medical, St Paul, MN) or SL0 sheath plus
8.5Fr steerable sheath (AgilisTM; Abott, Chicago,
Illinois) into the LA. For intraoperative anticoagulation, we injected
3000 units of heparin before and 5000 units just after the transseptal
puncture, followed by repetitive injection of 1000 to 2000 units of
heparin to maintain an activated clotting time greater than 300 seconds
during the procedure.