Ultrasound-guidance for femoral venipuncture reduces access site complications after ablation of atrial fibrillation and other left atrial tachycardias: a retrospective single- center analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Access site complications are significant adverse events related to ablation therapy. Periprocedural continuation of anticoagulation is common practice and leads to a reduction of cerebrovascular ischemic events but may increase the likelihood of access site complications. Methods 619 consecutive patients who underwent left-atrial ablation for AF were assessed for venipuncture associated complications after either landmark or ultrasound-guided venipuncture using data on hospital readmissions, outpatient visits or a structured telephone interview. AV-fistula, pseudoaneurysm and need of either interventional or surgical treatment of a vascular complication as well as blood transfusion were considered as access site complications. Continuous data are given as mean ± standard error of the mean, categorical data are expressed as number and percentages. Differences between groups were determined by Student’s t-test, chisquare-test, and Fisher’s exact test using SPSS software. A p-value of <0.05 was deemed significant. Results The patients' mean age was 69.1 ± 10.8 years and 51.5% were female. Mean BMI was 28.4 ± 5.5 kg/m2. Procedural safety was preserved with low observed rates of serious adverse events. The rate of postprocedural stroke (0.2% vs. 0%), pericardial effusion (0.8% vs. 0.6%) and in-hospital mortality (0% vs. 0%) did not differ between the groups. After conventional landmark-guided venipuncture the vascular complication rate was 4.8% (12/248). The rate of access site complications was significantly reduced to 0.8% (3/371) (p<0.01, OR 0.194, 95%-CI: 0.0529-0.712) when real time ultrasound-imaging was used for femoral venous cannulation. Severe bleeding complications related to the access site that required surgical or interventional treatment did not occur in the ultrasound group, compared to 2.0% (5/248) in the landmark-guided group (p = 0.010). The absolute risk reduction for access site complications using ultrasound-guidance was 3.2%, resulting in a number needed to treat (NNT) of 32 and a NNT of 50 for severe access site complications. Discussion Ultrasound-imaging while performing venipuncture identifies complex or uncommon anatomical conditions and facilitates safe cannulation of the common femoral vein. The use of ultrasound visual guidance for femoral sheath introduction had a remarkable beneficial effect on the occurrence of vascular access site complications in this retrospective single-center analysis. Outstandingly, the total rate of vascular access site complications had been significantly reduced resulting in a reduction of interventional or surgical treatment down to 0,0% in the us-guidance group, this may lead to fewer interruptions of OAC ant therefore lower risk of peri-interventional cerebrovascular events.