P456Ultrasound guidance for femoral venous access in patients undergoing pulmonary vein isolation: a quasi-randomized study

Abstract

Background The most common complications of electrophysiology (EP) procedures are related to vascular access. Purpose Our study aimed to compare the ultrasound (US)-guided (Group 1) vs. palpation-based (Group 2) technique for femoral venous access in atrial fibrillation (AF) ablation procedures. Methods Between January 2018 and October 2019, 355 patients undergoing pulmonary vein isolation (PVI) on uninterrupted anticoagulant treatment were included. They were allocated to Group 1 or 2 based on which of the two procedure rooms their procedure was scheduled in, with only one of the rooms equipped with an US machine including an 8 MHz linear transducer. Major and minor complications and the rate of prolonged hospitalization were compared in the two groups. Major vascular complication was defined as groin hematoma, arteriovenous fistula, or pseudoaneurysm. Hematoma was considered as a major vascular complication if it met type 2 or higher Bleeding Academic Research Consortium (BARC) criteria (requiring nonsurgical, medical intervention by a health care professional; leading to hospitalization or increased level of care, or prompting evacuation). Results Of the 355 patients 105 were allocated to Group 1 and 250 included in Group 2. Compared to the standard technique, the use of US significantly reduced both major (from 5.60% to 0.95%, p = 0.047) and minor (from 6.40% to 0.95%, p = 0.029) vascular complications. The absolute risk reduction (ARR) of minor/major vascular complications was 10.10% equated to a relative risk reduction (RRR) of 84.13%, and a number needed to treat (NNT) of 10 to prevent one bleeding event. No difference was found for the rate of prolonged hospitalization (5.04% vs. 0.95%, p = 0.119). Conclusion With the use of US for the femoral vein puncture in patients undergoing PVI procedure the rate of both major and minor vascular complications were lower.

Superior approach from the pocket for atrioventricular junction ablation performed at the time of conduction system pacing implantation

“…Furthermore, avoiding a FA at the time of the implantation procedure, the SA could potentially reduce the risk of device infection. Indeed, there is a lot of evidence suggesting that the insertion of catheters via the femoral vein (as for temporary transvenous pacing) immediately before the implantation of a device increases the risk of infection 24–26 . On the other hand, the SA could potentially increase the risk of infection as a result of the additional duration of the pocket opening during ablation 27 .…”

“…immediately before the implantation of a device increases the risk of infection. [24][25][26] On the other hand, the SA could potentially increase the risk of infection as a result of the additional duration of the pocket opening during ablation. 27 Future randomized trials with larger populations and longer observation periods will be needed to clarify these aspects.…”