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. 2022 Nov 15;11(22):6766.
doi: 10.3390/jcm11226766.

Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias

Leonie Foerschner  1 , Nico Erhard  1 , Stephan Dorfmeister  1 , Marta Telishevska  1 , Marc Kottmaier  1 , Felix Bourier  1 , Sarah Lengauer  1 , Carsten Lennerz  1 , Fabian Bahlke  1 , Hannah Krafft  1 , Florian Englert  1 , Miruna Popa  1 , Christof Kolb  1 , Gabriele Hessling  1 , Isabel Deisenhofer  1 , Tilko Reents  1
Affiliations

Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias

Leonie Foerschner et al. J Clin Med. .

Abstract

Background: Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. Methods: The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Results: Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95% CI 0.283−1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95% CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95% CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95% CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95% CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95% CI 0.000, 0.466). Conclusion: UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.

Keywords: atrial arrhythmias; catheter ablation; ultrasound-guided vascular access; vascular access complications; ventricular arrhythmias.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
UGVP in the right groin. (A) The operator holds the probe while puncturing with the other hand. (B) The optimal site for puncture with the vein and artery visualized side-by-side (A: artery; V: vein).
See this image and copyright information in PMC

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