Usefulness of 'figure-of-eight' suture to achieve haemostasis after removal of 15-French calibre femoral venous sheath in patients undergoing cryoablation

Abstract

Aims: Among patients undergoing cryoballoon-based atrial fibrillation (AF) ablation, in order to reduce access site complications, improve staff efficiency, and decrease length of stay, various techniques have been implemented to achieve immediate haemostasis. We aimed to assess the efficacy and safety of 'figure-of-eight (FoE)' suture when compared with conventional manual compression for immediate closure of 15-French (Fr) calibre right femoral venous access after cryoablation.

Methods and results: A total of 200 patients (48% female, mean age 55 ± 12.4 years, and 77% paroxysmal AF) with symptomatic AF underwent initial cryoablation procedure. All the patients were anticoagulated with heparin during the procedure. In a sequential allocation, FoE suture (Group 1 = 100) and conventional manual compression (Group 2 = 100) were used in achieving haemostasis at right femoral venous access site following 15 Fr sheath removal. In the FoE suture group, haemostasis was achieved immediately after tying the knot (n = 95) or within ≤1 min of light pressure (n = 4). One patient had failure of the stitch as the silk suture snapped during knotting, and haemostasis was achieved by manual compression as per the usual protocol. The median time to haemostasis was shorter in the suture group (0 vs. 14 min, P < 0.001). On immediate and short-term (3 months) follow-up, there was no evidence of minor or major vascular access site complications like haematoma, re-bleeding, fistula formation, or thrombosis at right femoral site in the suture group.

Conclusion: The 'FoE' suture, as a simple, efficacious and likely safe technique, might be an alternative approach to achieve an immediate haemostasis after removal of 15 Fr right femoral venous sheaths in patients undergoing cryoablation.

Keywords: Atrial fibrillation; Cryoablation; Femoral vein haemostasis.