Ultrasound‐Guided Venous Puncture in Electrophysiological Procedures: A Safe Method, Rapidly Learned

Errahmouni, Abdelkarim; Bun, Sok‐Sithikun; Laţcu, Decebal Gabriel; Saoudi, Nadir

doi:10.1111/pace.12386

Cited by 39 publications

(30 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This finding is a testament to the protective effect of US, apparent even in the cohort at greater risk for bleeding. Similar improved outcomes have been corroborated by publications from three other institutions, forming a robust experience that confirms the effectiveness of US in reducing vascular complications during EP procedures [13][14][15]. A summary of these four publications by Sobolev et al, including over 4000 subjects, showed a 60% reduction of major vascular complications and 66% reduction of minor ones [16].…”

supporting

confidence: 64%

Ultrasound guided vascular access in the electrophysiology lab: should it be a standard of care?

Tanaka-Esposito

Tchou

2017

J Interv Card Electrophysiol

View full text Add to dashboard Cite

Catheter directed electrophysiology (EP) studies and ablations have emerged as common and widely accepted therapies for various types of arrhythmia. The femoral vasculatures serve as access sites, in the majority of instances. Despite the need for multiple venous sheath placement within a single vein, early reporting of vascular related bleeding complications was naught [1,2]. With increasing frequency of complex procedures such as pulmonary vein antral isolation (PVAI) performed with maintenance of peri-procedural anticoagulation and those necessitating arterial access, vascular complication rates rose to 1-2% [3,4]. In spite of advancements in catheterbased EP procedures in the past two decades leading to improved efficacy and overall safety, the incidence of vascular complication has remained unchanged [5,6].Vascular complications directly impact patient morbidity and increase health care costs. They are usually the consequence of inadvertent arterial puncture and cannulation, particularly when using large diameter sheaths and/or with aggressive anticoagulation. Baum et al. described overlap of the femoral artery (CFA) and common femoral vein (CFV) along some portion of their course in two-thirds of patients studied, predisposing to simultaneous puncture of the overlapping artery during intended venous cannulation and resulting in arteriovenous fistula formation. High bifurcation of the CFA at the level of the mid femoral head was also found to be not uncommon [7]. Such anatomic variation cannot be appreciated without real-time imaging, and increases risk for pseudoaneurysm formation due to accidental puncture of the superficial femoral artery [8].Real-time ultrasound guidance (US) allows direct visualization of vascular structures, and its use has been shown to significantly improve procedural success and/or reduce complications. US has been endorsed in Practice Guidelines put forth by various societies [9][10][11]. Yet in spite of wide acceptance in the medical and surgical communities, US guidance has not been routinely utilized in all EP labs. The first reported comparative study was from our institution and included 3510 patients undergoing PVAI, requiring multiple femoral venous accesses [12]. US guided femoral venous access reduced total and major vascular complications by 3-fold and 7-fold. This result was even more significant, given that 73% of patients undergoing US guided venipuncture had an INR ≥1.9 on the day of the procedure. This was in comparison with the non-US guidance group, in whom only 9% of patients had an INR ≥1.9 on the day of the procedure. This finding is a testament to the protective effect of US, apparent even in the cohort at greater risk for bleeding. Similar improved outcomes have been corroborated by publications from three other institutions, forming a robust experience that confirms the effectiveness of US in reducing vascular complications during EP procedures [13][14][15]. A summary of these four publications by Sobolev et al., including over 4000 subjects, showed a 60% re...

show abstract

supporting

confidence: 64%

Ultrasound guided vascular access in the electrophysiology lab: should it be a standard of care?

Tanaka-Esposito

Tchou

2017

J Interv Card Electrophysiol

View full text Add to dashboard Cite

show abstract

“…Procedures were performed with vitamin K antagonist continuation with a target internalized normalized ratio of 2.0‐3.0, or direct oral anticoagulant (dabigatran, rivaroxaban, or apixaban given in the evening before the procedure if trans‐septal puncture was performed, or in the morning of the procedure in case of RA‐only ablation), under conscious sedation or general anesthesia in a fasting state. All catheters were advanced via the femoral vein after ultrasound‐guided venous puncture . A 6‐F steerable decapolar catheter (Irvine Bio Inc., St. Jude Medical Inc., St. Paul, MN, USA) was positioned in the CS, and served as a reference.…”

Section: Methodsmentioning

confidence: 99%

Cavotricuspid isthmus is constantly a zone of slow conduction: Data from ultra‐high‐resolution mapping

Bun

Laţcu

Wedn

et al. 2020

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

Background Whether cavotricuspid isthmus (CTI) is a region of conduction slowing during typical flutter has been discussed with conflicting results in the literature. We aimed to evaluate conduction velocity (CV) along the different portions of the typical flutter circuit with a recently proposed method by means of ultra‐high‐resolution (UHR) mapping. Methods Consecutive patients referred for typical atrial flutter (AFL) ablation underwent UHR mapping (Rhythmia, Boston Scientific). CVs were measured in the CTI as well as laterally and septally, respectively, from its lateral and septal borders. Results A total of 33 patients (mean age: 65 ± 13 years; right atrial volume: 134 ± 57 mL) were mapped either during ongoing counterclockwise (n = 25), or clockwise (n = 3) AFL (mean cycle length: 264 ± 38 ms), or during coronary sinus pacing at 400 ms (n = 1), 500 ms (n = 1), or 600 ms (n = 3). A total of 13 671 ± 7264 electrograms were acquired in 14 ± 9 min. CTI CV was significantly lower (0.56 ± 0.18 m/s) in comparison with the lateral CV (1.31 ± 0.29 m/s; P < .0001) and the septal border CV of the CTI (1.29 ± 0.31 m/s; P < .0001). Conclusion UHR mapping confirmed that CTI CV was systematically twice lower than atrial conduction velocities outside the CTI.

show abstract

“…Procedures were performed with vitamin K antagonist continuation with a target INR of 2.0–3.0. All catheters were advanced via the femoral vein under ultrasound guidance . Intravenous heparin was administered immediately after the insertion of the femoral sheaths, and continuously given to maintain an activated clotting time of 300–350 seconds throughout the procedure.…”

Section: Methodsmentioning

confidence: 99%

Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use

Bun

Ayari

Laţcu

et al. 2017

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

Ultrasound‐Guided Venous Puncture in Electrophysiological Procedures: A Safe Method, Rapidly Learned

Abstract: UGVP is a short learning curve technique, significantly associated with a low incidence of minor VCs. This study supports wide use of UGVP in patients undergoing EP procedures.

Cited by 39 publications

References 16 publications

Ultrasound guided vascular access in the electrophysiology lab: should it be a standard of care?

Ultrasound guided vascular access in the electrophysiology lab: should it be a standard of care?

Cavotricuspid isthmus is constantly a zone of slow conduction: Data from ultra‐high‐resolution mapping

Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use

Contact Info

Product

Resources

About