QI-452785-4 DURING CARDIAC ELECTROPHYSIOLOGY PROCEDURES ULTRASOUND GUIDANCE OF VENOUS PUNCTURE REDUCES MAJOR AND TOTAL VASCULAR COMPLICATIONS - A META-ANALYSIS

Abstract

Puncture site vascular complications (VCs) are the most common complications of invasive electrophysiology (EP) procedures. The use of vascular ultrasound during puncture is already included in the guidelines of other medical fields, e.g. intensive care, and also widely used in EP labs around the world, but not yet standard practice in all of them. Our aim was to conduct a meta-analysis which compares anatomical guidance to the use of ultrasound during the femoral venous puncture in conjunction with electrophysiology procedures. In contrast to the previous meta-analyses, we aimed to use a uniform endpoint and to involve new publications to improve patients numbers. In order to find articles which report, both with and without ultrasound guidance, the rate of vascular complications during EP procedures, a systematic search was performed in the relevant electronic databases. Major VCs (MVCs), as defined in the 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus) were the primary endpoint. AV-fistula, pseudoanerurysm and major bleeding (each separately), minor VCs, total VCs and inadvertent arterial punctures were defined as secondary endpoints, For statistical analysis we used a random effects model with the Mantel-Haenszel method. Data on 23605 patients was reported by the 14 articles matching our selection criteria. The primary outcome was reported on 13050 of them (in 10 articles), with 200 (156 %) reaching the primary endpoint of an MVC. The occurrence of MVCs was significantly reduced by the routine use of ultrasound during the puncture (29/4542 vs. 171/8508, OR 0.22 [0.10-0.50], p<0.001). Moreover, the incidence of several secondary endpoints was also significantly lower: total vascular complications – OR 0.27 [0.13-0.53] (p<0.001), minor vascular complications: OR 0.25 [0.16-0.74], accidental artery puncture – OR was 0.20 [0.09-0.41] (p<0.001). There was insufficient data reported regarding AV-fistula, pseudoanerurysm and major bleeding specifically. While using a more uniform MVC definition compared to previous meta-analyses and covering more than 1.5 times as many patients, we demonstrated that ultrasound guidance for femoral venous puncture during EP procedures is significantly beneficial. Above all, the rate of MVCs and total VCs is reduced by this technique. These results show that its routine use should be considered in every EP lab and this could bring important improvements in patient safety.