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Impact of optimized vascular access and post-interventional groin-site management during electrophysiology procedures

https://doi.org/10.1007/s00392-024-02526-y

Niklas Schenker (Hamburg)1, J. Obergassel (Hamburg)1, C. Asbeck (Hamburg)1, M. Lemoine (Hamburg)1, D. Ismaili (Hamburg)1, I. My (Hamburg)1, F. Moser (Hamburg)1, J. Rieß (Hamburg)1, M. Nies (Hamburg)1, P. Kirchhof (Hamburg)1, F. Ouyang (Hamburg)1, B. Reißmann (Hamburg)1, A. Rillig (Hamburg)1, A. Metzner (Hamburg)1, L. Rottner (Hamburg)1

1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland

 

Background: Catheter ablation of cardiac arrhythmias is an established treatment strategy, but the optimal vascular access strategy is still under debate.

Purpose: The aim of the study was to assess the impact of ultrasound-guided versus conventional femoral vein access and of a modified groin-site management on periprocedural safety. 

Method: Patients undergoing electrophysiology (EP) procedures at the University Heart and Vascular Center Hamburg are prospectively included in the TRUST registry. Groin management including conventional vascular access and post-interventional groin pressure-bandage of 6 hours (group I) was compared to ultrasound-guided vascular access, venous closure by Z-suture and groin pressure-bandage for 2 hours plus additional 4 hours bed-rest time (group II). Hematoma, persistent bleeding, arteriovenous fistula or femoral pseudoaneurysm, which did not require further intervention were classified as minor complications, aforementioned complications requiring intervention or retroperitoneal hematoma as major complications.

Results: 779 (51 %) procedures in 705/1381 patients (51%) within group I (39% female, age 65 [IQR 56,74] years, CHA2DS2-VASc-Score 2 [1,4]) and 756 (49%) procedures in 676/1381 (49%) patients within group II (37% female, age 65 [IQR 55,73] years, median CHA2DS2-VASc-Score 2 [1,4]) without differences between groups (p=0.528, p=0.479 and p=0.079, respectively) were analyzed. In group I and group II, 39%/44% procedures were index pulmonary vein isolations, 30%/29% repeat atrial fibrillation ablations, 16%/15% procedures for supraventricular tachycardia, 12%/11% PVC or VT ablations and 4%/2% left atrial appendage occlusions. Overall complication rate was 9% in group I, and 5% in group II (OR 0.54 [95%-CI 0.35-0.82], p=0.003). Major groin complications occurred in 19/779 (2%) procedures and in 10/756 (1%) procedures (OR 0.53 [95%-CI 0.22-1.22], p=0.156) respectively.

Conclusion: A novel institutional standard for groin management in EP procedures including ultrasound-guided vascular access significantly reduces overall vascular access complication rate. 

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