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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.

Background We meta‐analyzed the efficacy and safety of catheter (CA) vs thoracoscopic (TA) ablation for atrial fibrillation (AF). Methods PubMed, Embase, and Cochrane databases were searched until 31/12/2019 for relevant randomized trials and subsequent pooled analyses. Results In six trials totaling 465 patients (254 CA/211 TA), 1‐year AF recurrences were higher for CA (46% vs 26%, odds ratio 2.90 [95% CI 1.32‐6.38]), whereas total adverse events were lower (10% vs 25%, 0.35 [0.14‐0.86], respectively). Conclusion CA has lower efficacy but higher safety than TA. CA should remain the first‐line AF ablation strategy, and TA reserved for selected CA‐resistant patients where rhythm control is clinically necessary.

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