Femoral vascular complications after catheter ablation in the current era: The utility of computed tomography imaging

Abstract

Background: Few studies have examined the characteristics of catheter ablation vascular complications, and recently physicians increasingly use computed tomography angiography (CTA) for diagnosing.Objective: We sought to investigate the incidence of femoral vascular complications in catheter ablation and factors associated with complications in the current era. Methods: This single-center observational study consisted of 311 consecutive (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, and ventricular arrhythmias in 222 [71.4%], 7 [2.3%], 43 [13.8%], and 39 [12.5%]) patients who underwent catheter ablation. The detailed patient data and clinical outcomes were obtained from the medical records.Results: Emergent CTA was performed in a total of 8 (2.6%) patients at a median of 4.5 (2.0-12.5) days postprocedure, and the precise diagnosis was obtained in all.Among them, pseudoaneurysms, arteriovenous fistulae (AVF), and actively bleeding hematomas were identified in two, one, and one patient, respectively, and all required readmissions after discharge. AVF was diagnosed by a Doppler ultrasound examination in another patient. In total, 5 (1.6%) patients exhibited major femoral vascular complications including two pseudoaneurysms, two AVFs, and one active bleeding hematoma. The pseudoaneurysms and AVFs were successfully eliminated by direct compression, and extravasation from the femoral circumflex artery required coil embolization. Antiplatelet therapy and the use of larger arterial sheaths (≥7-Fr) increased the major femoral arterial complications, but atrial fibrillation ablation under uninterrupted anticoagulation therapy or the use of larger venous sheaths did not.Conclusion: Vascular complications are still not negligible procedure-related complications during catheter ablation in the current era. CTA provides a rapid and precise diagnosis for optimal treatment strategies. K E Y W O R D Sarteriovenous fistula, catheter ablation, complication, pseudoaneurysm 1392 | ISHIKAWA ET AL. endovascular, and surgical treatments. Antiplatelet therapy and larger arterial sheath use were associated with a higher incidence of major vascular complications.

Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology

“…While ultrasound is easily accessible at bedside and the method of choice for diagnosis of pseudo-aneurysms, in patients with suspected haemorrhage, CT is advised for a precise diagnosis. 179 , 182 Haematoma is identified by hypoattenuation, by swelling of adjacent muscle, and, subacutely, by a heterogeneous pattern (‘haematocrit sign’ 179 ) A bolus-triggered CT angiogram following application of iodinated contrast media detects the source of active bleeding ( Table 13 , Figure 13 ).…”