Meta‐analysis of ultrasound‐guided vs conventional vascular access for cardiac electrophysiology procedures

Abstract

BackgroundVascular complications are common during invasive cardiac electrophysiology procedures. This meta‐analysis compares outcomes following ultrasound and nonultrasound‐guided vascular access for these procedures.MethodsPubMed, Embase and Cochrane 01/01/1980‐30/09/2018 were searched for relevant studies to meta‐analyse.ResultsSeven studies (6269 patients) were included. Pooled rates and odds ratio(95% confidence interval) for ultrasound and nonultrasound subgroups were 1.2% vs 3.0%, 0.32 (0.21‐0.49) for all vascular complications, with less hematomas and arterial punctures but similar arteriovenous fistulas, pseudoaneurysms or retroperitoneal bleeds.ConclusionUltrasound guidance had less complications due to less hematoma and arterial puncture, and is generally recommended for electrophysiology procedures.

Catheter ablation for tachyarrhythmias during pregnancy

“…For these rare clinical situations, some challenging aspects in relation to catheter ablation during pregnancy including drug challenges (isoproterenol) or the use vascular access, gestational age, anesthesiologist presence during the procedure and the guidelines or practical clinical management strategies for peri-procedural assessment of fetus status and implementation of this approaches in different countries and health care systems should be addressed (Table IV) [55][56][57][58][59][60][61]. Isoproterenol is a β-receptor Advances in Interventional Cardiology 2022; 18, 3 (69)…”

“…• Heart rate increases >20 beats per minute in anesthetized adults (isoproterenol 3 μg i.v.) • In 60 non-laboring women at term, consistently increased both maternal heart rate and uterine blood flow (injection of isoproterenol 5 μg) • Inducing a faster onset of analgesia but shorter duration of analgesia (addition of isoproterenol to sufentanil and bupivacaine) [56] • Treating refractory symptomatic bradycardia in parturients with congenital complete heart block (isoproterenol infusion) [57] Vascular access • Femoral access (usually the right femoral vein) was preferred for the vessel size and for better manipulation of the ablation catheter [14] • Transseptal puncture performed using the Brockenbrough technique can be advanced to the left atrium and could be guided to all four pulmonary veins and the mitral annulus using intracardiac echocardiography [16], for ablation of the left lateral accessory pathway [20] • Retrograde approach by the femoral artery was for ablation of para-Hisian (non-coronary cusp) arrhythmias [21] • The femoral transaortic approach was used for left side accessory pathway ablation [23] • In pregnant women catheters can be introduced into the right heart or the great cardiac vein by the right internal jugular vein [36] • Ultrasound-guided access strategy: reductions in minor complications such as local hematoma and inadvertent arterial puncture and major and potentially fatal complications such as retroperitoneal hematoma [58] Gestational age • The best time to intervene is considered to be after the fourth month in the second trimester [46,47] • There is a definite risk to the fetus in all trimesters of pregnancy with group D drugs (aminoglycosides, quinolones and tetracyclines) and they should only be used for vital indications [46,47] • β-blockers should be used with caution in the first trimester [45,46] • Most electrophysiological studies should only be performed if arrhythmias are medically refractory and cause hemodynamic compromise [47] • All antiarrhythmic drugs should be avoided if possible, especially during the first trimester as potentially toxic to the fetus [45,49] • Due to the high radiation exposure, ablation should be postponed to the second trimester if possible [46,47,49] • Catheter ablation is the procedure of choice for drug-refractory, poorly tolerated supraventricular tachycardia.…”

Peripheral vascular access from the arms for electrophysiology procedures using ultrasound guidance

“…[24][25][26] The role of ultrasound has become increasingly integrated into interventional cardiac procedures. 27 It enables visualisation of the vasculature, assessment of the depth and diameter of a vessel, and assessment of an optimal route for access. Additionally, it eliminates the guesswork involved in traditional puncture techniques, minimises the risk of entering the incorrect vessel, or puncturing the posterior wall, and subsequent development of haematomas.…”

Can all stakeholders benefit from same‐day discharge following catheter ablation of atrial fibrillation?

“…3 The adoption of ultrasound-guided vascular access has led to a 2/3 decrease in procedural vascular complications. 4 Transseptal puncture, which many physicians consider one of the most dreaded steps of the procedure, has become safer under direct visualization guided by intracardiac echo and three-dimensional mapping, using the supplies, facility, and pharmacy costs were lower by 7%, 89%, and 71% in the SDD cohort, at the expense of the device closure implants. Surprisingly in their healthcare system, the analysis resulted in a net even cost, with an actual overall 1.35% higher cost for SDD discharge using device closure implants, compared with an overnight stay, despite the cost values being corrected for inflation.…”

“…The adoption of ultrasound‐guided vascular access has led to a 2/3 decrease in procedural vascular complications 4 . Transseptal puncture, which many physicians consider one of the most dreaded steps of the procedure, has become safer under direct visualization guided by intracardiac echo and three‐dimensional mapping, using special radiofrequency wires like VersaCross® (Baylis Medical) 5 …”