Figure-of-eight suture for venous hemostasis in fully anticoagulated patients after atrial fibrillation catheter ablation

Abstract

Introduction: Limited data exists for types of venous closure and its associated complications in patients after atrial fibrillation (AF) catheter ablation. We evaluated the subcutaneous figure-of-eight closure (FO8) for achieving venous hemostasis after AF catheter ablation compared to manual pressure.

Methods: 284 consecutive patients that underwent AF catheter ablation by two operators were included. All patients received continuous therapeutic warfarin or interrupted novel oral anticoagulants (NOAC) and heparin (ACT300-400 s) without reversal. Patients were divided into two groups: 1) sheaths were left in place and pulled once ACT < 180 s, with hemostasis being achieved with manual pressure (MP); and 2) a subcutaneous FO8 suture closed the venous access site immediately after the ablation on each groin site and sheaths were removed immediately after the ablation despite full anticoagulation with heparin and warfarin or interrupted NOAC. Sutures were removed after four hours, and the patients laid flat for an additional two hours.

Results: The MP group (n = 105) was similar to the FO8 group (n = 179). Time in bed was 573 ± 80 min for MP group vs. 373 ± 49 min for FO8 group (p < 0.0001). Eleven hematomas were seen in the MP group compared to seven in the FO8 group (P = 0.041).

Conclusions: In fully anticoagulated patients undergoing AF catheter ablation, excellent hemostasis was achieved with figure-of-eight sutures, with no major vascular complications, a lower hematoma rate, and a significantly shorter flat-time-in-bed compared to manual pressure.

Keywords: Anticoagulation; Atrial fibrillation ablation; Figure of 8 suture; Venous hemostasis.

Fig. 1

(A) A 1 silk suture attached to a curved needle is passed medially to laterally on the body, on a plane just inferior to the sheath and deep into the subcutaneous tissue. (B–C) The needle is brought medially to laterally on the body, on a plane just superior to the sheath and deep into the subcutaneous tissue.

Fig. 2

(A–B) Figure-of-8 configuration prior to locking suture. (C) Both the sheaths are pulled out while maintaining traction on the suture. (D) Completed right groin figure-of-8 suture.