Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias

Abstract

Background: Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. Methods: The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Results: Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95%CI 0.283–1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95%CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95%CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95%CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95%CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95%CI 0.000, 0.466). Conclusion: UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.

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“…Third, the success rate depends on individual knowledge, experience and skills; however, a chronological analysis of the success rates is impossible due to the small sample size. Fourth, only the sequential unipolar radiofrequency ablation technique was used in this study; employing novel approaches and adjunctive devices at an advanced cardiac centre could significantly improve efficacy and safety 20 21 27 32 33. Additionally, due to the absence of ICE, it was impossible to localise the PVC/VT origins to endocavitary structures 27 30 34 35.…”

Impact of intracardiac echocardiography usage on the safety of cryoballoon atrial fibrillation ablation: Subanalysis of the prospective FREEZE cluster cohort study

“…20 Other factors in addition to operator experiences, such as female sex, vessel anatomy, anticoagulation strategy, protamine use, postprocedural care, and the use of a figure-of-eight suture, can contribute to groin complications in clinical practice. [21][22][23] In those centers with ICE available in the EP lab, the immediate availability of vascular ultrasound may increase the rate of ultrasound-guided venous puncture, which might have led to lower vascular complication rates in the ICE group.…”

“…In centers performing conventional transseptal puncture, a pigtail catheter might have been positioned in the aortic root via a femoral artery as anatomical landmark, which might have influenced the complication rates 20 . Other factors in addition to operator experiences, such as female sex, vessel anatomy, anticoagulation strategy, protamine use, postprocedural care, and the use of a figure‐of‐eight suture, can contribute to groin complications in clinical practice 21–23 . In those centers with ICE available in the EP lab, the immediate availability of vascular ultrasound may increase the rate of ultrasound‐guided venous puncture, which might have led to lower vascular complication rates in the ICE group.…”

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