ULTRASOUND-GUIDED FEMORAL VENIPUNCTURE FOR CATHETER ABLATION OF ATRIAL FIBRILLATION: CLINICAL BENEFIT

Purpose: Vascular complication rates of ultrasound-guided venipuncture (USGV) were analyzed and compared to historical controls (CTRL) with an anatomical landmark-guided approach.

Methods: The study cohort included 4646 consecutive patients (2330 and 2316 patients in USGV and CTRL groups, respectively). Clinical characteristics were as follows: age of 61±10 years, 67% males, 66% paroxysmal AF, CHA2DS2-VASc score of 2.0±1.4, 27% reablation, and procedure time of 208±69 min. Both femoral veins were cannulated with 2 and 2 sheaths (7, 11, and 2x 8.5 French) in the majority (>95%) of procedures. Major complications were defined as those requiring intervention, or hematoma/bleeding with hemoglobin drop >30g/l, or condition prolonging hospitalization.They were extracted from the institutional tracking system for complications of invasive procedures and by a review of medical reports within the first 3 months of follow-up.

Results: There were 32 (1.38%) vs. 62 (2.66%) major complications related to vascular access in USGV and CTRL groups, (P=0.003), i.e. relative reduction of -48% in the USGV group. Surgical intervention was needed in 6 (0.26%) vs. 18 (0.77%) patients, respectively (Fisher exact test P=0.02), i.e. relative reduction of -64% in the USGV group. The differences remained significant after adjustment for baseline clinical characteristics. Multivariate analysis revealed that USGV strategy (P=0.0005), male gender (P=0.003), and less advanced age (P=0.0002) were significantly associated with lower complication rates.

Conclusions: USGV was associated with a statistically significant reduction of major vascular complications after catheter ablation for AF. This strategy also decreased the need for surgical correction of vascular complications. Ultrasound guidance can be recommended to improve the safety of femoral venous access.