Value of ultrasound for access guidance and detection of subclinical vascular complications in the setting of atrial fibrillation cryoballoon ablation

Ströker, Erwin; Asmundis, Carlo de; Kupics, Kaspars; Takarada, Ken; Mugnai, Giacomo; Cocker, Jeroen De; Stockman, Dirk; Sieira, Juan; Schwagten, Bruno; Brugada, Pedro; Greef, Yves De; Chierchia, Gian Battista

doi:10.1093/europace/euy154

Cited by 29 publications

(21 citation statements)

References 15 publications

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“…The rate of hematoma has been reported between 1.2% and 1.4%; however, the rate of hematoma in our study was slightly lower at 0.67%–0.93%. Ultrasound guidance to obtain vascular access may have contributed to the low rate of vascular complications in our trial 14 . The risk of stroke in previous studies has been reported between 0.23% and 0.30%, which is slightly higher than observed in our study 12,13 .…”

Section: Discussioncontrasting

confidence: 50%

Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

Kowalski

Parikh

Salcido

et al. 2020

Cardiovasc electrophysiol

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Background It is common practice to observe patients during an overnight stay (ONS) following a catheter ablation procedure for the treatment of atrial fibrillation (AF). Objectives To investigate the safety and economic impact of a same‐day discharge (SDD) protocol after cryoballoon ablation for treatment of AF in high‐volume, geographically diverse US hospitals. Methods We retrospectively reviewed 2374 consecutive patients (1119 SDD and 1180 ONS) who underwent cryoballoon ablation for AF at three US centers. Baseline characteristics, acute procedure‐related complications, and longer‐term evaluations of safety were recorded during routine clinical follow‐up. The mean cost of an ONS was used in a one‐way sensitivity analysis to evaluate yearly cost savings as a function of the percentage of SDD cases per year. Results The SDD and ONS cohorts were predominately male (69% vs. 67%; p = .3), but SDD patients were younger (64 ± 11 vs. 66 ± 10; p < .0001) with lower body mass index (30 ± 6 vs. 31 ± 61; p < .0001) and CHA2DS2‐VASc scores (1.4 ± 1.0 vs. 2.2 ± 1.4; p < .0002). There was no difference between SDD and ONS in the 30‐day total complication rate (n = 15 [1.26%] versus n = 24 [2.03%]; p = .136, respectively). The most common complication was hematoma in both the SDD (n = 8; 0.67%) and ONS (n = 11; 0.93%) cohorts. Sensitivity analysis demonstrated that when 50% of every 100 patients treated were discharged the same day, hospital cost savings ranged from $45 825 to $83 813 per year across US hospitals. Conclusions SDD following cryoballoon ablation for AF appears to be safe and is associated with cost savings across different US hospitals.

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Section: Discussioncontrasting

confidence: 50%

Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

Kowalski

Parikh

Salcido

et al. 2020

Cardiovasc electrophysiol

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“…Nine studies involving 8232 patients met our inclusion criteria, published between 2013 and 2018. One study was randomized and eight were observational, non-randomized (Table 1) [12,[15][16][17][18][19][20][21][22]. The results of the literature search are summarized in Fig.…”

Section: Resultsmentioning

confidence: 99%

Ultrasound guidance for femoral venous access in electrophysiology procedures—systematic review and meta-analysis

Kupó

Pap

Sághy

et al. 2019

J Interv Card Electrophysiol

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Purpose The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. Methods Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/ without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). Results Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = − 92.1 s, 95% CI, − 142.12-− 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). Conclusion Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.

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“…18,19 Since the introduction of ultrasound to obtain vascular access, these complications have been all but eradicated. 20 The Recently, several studies from a single center have been published demonstrating the benefits of weight loss in patients with AF. 15,[21][22][23] Of these, the ARREST-AF trial was designed to evaluate outcomes specifically in patients undergoing AF ablation.…”

Section: Discussionmentioning

confidence: 99%

“…This is almost certainly because the most common complications of AF ablation have historically been related to vascular access, and these are particularly more likely in obese patients 18,19 . Since the introduction of ultrasound to obtain vascular access, these complications have been all but eradicated 20 . The risk of cardiac tamponade has been mitigated in recent years by the use of transesophageal echocardiography to guide transseptal punctures, and the introduction of contact force‐sensing and cryoballoon ablation catheters, both of which were used in this study.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of weight loss in obese atrial fibrillation patients attending a specialist arrhythmia clinic and its impact on ablation outcomes

Ding

Kozhuharov

Chin

et al. 2020

Journal of Arrhythmia

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Background The feasibility of significant weight reduction in a specialist arrhythmia service, and its impact on atrial fibrillation (AF) ablation outcomes are unclear. We aimed to assess these factors in a real‐world cohort in the United Kingdom. Methods Patients from one specialized arrhythmia clinic were instructed to follow the “Intermittent Fasting 5:2 diet” (“diet group”, n = 50), and their outcomes were compared to a propensity matched cohort who received no specific dietary advice (“control group”, n = 42). The primary outcome was recurrence of AF or atrial tachycardia (AT) at 12 months postablation, with or without drugs. Results Body weight and body mass index (BMI) at baseline were 105.0 (±15.3) kgs and 36.0 (±4.0), respectively. Baseline characteristics between the two groups were comparable. Patients in diet group experienced a mean weight loss of 8.2 (±7.1) kgs prior to AF ablation (P < .01 for comparison to baseline and control group). About 14 (28%) patients in the diet group lost >10% of their body weight. Overall, 11 (22%) patients in the diet group and five (12%) in the control group had AF recurrence at 1 year, P = .21. AF recurrence was similar in patients with BMI ≥ 35 (15%) as compared to BMI < 35 (19%), P = .60. There was one procedural complication (pulmonary edema) in the diet group. Conclusion It is feasible to achieve significant weight reduction in obese AF patients in a specialist arrhythmia clinic setting with unsupervised dietary advice. Low rates of procedural complications and excellent medium‐term success rates were observed in this traditionally challenging population. Additional improvements in outcomes were not demonstrable in patients who exhibited significant weight loss.

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Value of ultrasound for access guidance and detection of subclinical vascular complications in the setting of atrial fibrillation cryoballoon ablation

Abstract: US-guided venipuncture was associated with a near-to-zero risk of vascular complications in our patients undergoing CB ablation.

Cited by 29 publications

References 15 publications

Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

Same‐day discharge after cryoballoon ablation of atrial fibrillation: A multicenter experience

Ultrasound guidance for femoral venous access in electrophysiology procedures—systematic review and meta-analysis

Feasibility of weight loss in obese atrial fibrillation patients attending a specialist arrhythmia clinic and its impact on ablation outcomes

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