Comparison of standard vs modified “figure‐of‐eight” suture to achieve femoral venous hemostasis after cryoballoon based atrial fibrillation ablation

Abstract

Background Immediate hemostasis following removal of sheaths is essential to prevent access site complications after atrial fibrillation (AF) ablation. Despite various precautions to achieve complete hemostasis in a safe and effective manner, no standard approach is present yet. Objective We aimed to compare the efficacy and safety of standard vs modified figure‐of‐eight (sFoE vs mFoE) suture for immediate venous hemostasis after cryoballoon (CB) AF ablation. Methods A total of 150 patients who underwent CB catheter ablation were sequentially allocated to either sFoE (n = 75) or mFoE (n = 75) suture to achieve immediate venous hemostasis at right femoral access site after 15 Fr sheath removal. A “three‐way stopcock” was used in the mFoE group rather than tying the knot as in a sFoE group. Demographics, clinical and procedural data, and access site complications were recorded. Results Immediate haemostasis was achieved in all patients (n = 75) with mFoE suture as compared to 90.7% (n = 68) of sFoE suture group (P < .001). Light manual pressure of ≤1 min was required in five patients (6.7%) due to looseness and conventional manual compression because of the snapped silk suture during knotting was required in two patients (2.6%) in the sFoE group. Time to hemostasis was shorter in the mFoE group (P < .001), but time to ambulation and time to discharge were similar in both groups (P > .05). Although no minor or major access site complication has occurred in the mFoE group, in‐hospital rebleeding (n = 2, 2.7%) and early local access site infection (n = 2, 2.7%) were observed in the sFoE group. Conclusion The mFoE suture using three‐way stopcock is an available, effective, maybe safe, and time‐ and cost‐saving alternative technique to achieve immediate hemostasis after removal of 15 Fr right femoral venous sheath in patients undergoing cryoablation.

A comparison of figure‐of‐8‐suture versus manual compression for venous access closure after cardiac procedures: An updated meta‐analysis

“…F8 can be performed in a very short duration (30‐60 s), and its failure has been attributed to inadequate knot tie or suture break 4,6 . A modified F8 suture, where a three‐way stopcock is utilized instead of knots, was evaluated by Yorgun et al In comparison to the standard F8 suture, the use of the modified F8 resulted in a shorter time to hemostasis with no documented minor or major access site complication 27 . A single F8 suture may be utilized for attaining hemostasis after multiple ipsilateral femoral venous access; however, its use may be restricted if there is a need to close both an ipsilateral arterial and venous access site which can have an impact on mobilization time.…”

Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

“…Although we did not perform individual analysis of patient comfort, the SCT appeared to be better accepted by patients due to ease of suture removal. A recent article by Yorgun et al analyzed the efficacy and safety of F8S vs SCT. Their data revealed a 1.3% rate of suture failure compared to 0.3% rate in our study.…”

“…Their data revealed a 1.3% rate of suture failure compared to 0.3% rate in our study. As opposed to Yorgun et al, our study included a larger number of patients, 91.9% radiofrequency ablation procedures (vs exclusively cryoablation), with no femoral arterial access. Hemostasis effectiveness in radiofrequency ablation vs cryoablation was not analyzed by us as the overall access site complication rate was too low.…”

Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review

“…Device-based invasive vascular closure techniques have significant cost with a risk of device failure and specific vascular complications [31] . Despite, modified figure-of-eight suture for femoral venous hemostasis has been found to be safe and time saving hemostasis method for CB procedures [32] , manual compression is the most commonly used technique to achieve access site hemostasis after CB procedure. Protamine reversal of anticoagulation may be an option for veinous hemostasis during manual compression.…”