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. 2025 Jul 1;27(7):euaf117.
doi: 10.1093/europace/euaf117.

Vascular access site management during electrophysiology procedures: a European Heart Rhythm Association survey

Mark T Mills  1   2 , Dhiraj Gupta  1   2 , Vishal Luther  1   2 , Maura M Zylla  3 , Piotr Futyma  4 , Laura Perrotta  5 , Michal Mazurek  6 , Christian-Hendrick Heeger  7 , Lina Marcantoni  8 , Andreas Metzner  9 , Julian K R Chun  10
Affiliations

Vascular access site management during electrophysiology procedures: a European Heart Rhythm Association survey

Mark T Mills et al. Europace. .

Abstract

Aims: Reliable vascular access and haemostasis techniques are important to the safety of electrophysiology (EP) procedures. This European Heart Rhythm Association (EHRA) survey aimed to evaluate contemporary vascular access site management practices across international EP centres.

Methods and results: A 30-question survey was disseminated via the EHRA between March and April 2025, with 401 responses from professionals across 51 countries. Most respondents were cardiology consultants/attendings (82.0%), with 57.3% performing over 150 EP procedures annually. Ultrasound guidance for vascular access was usually or always used by 71.7%, though 21.4% used it rarely or never, and only 17.3% had received formal ultrasound training. Institutional protocols for haemostasis were lacking in around half (46.8%) of centres. Suture-mediated closure was the most common method for haemostasis (60.4%), followed by manual compression (33.0%) and vascular closure devices (VCDs, 5.8%). The figure-of-eight suture with a hand-tied knot was the most frequently used suture technique (79.7%). Just over a third (36.0%) had experience with VCDs, typically reserved for high-risk cases. For procedures requiring transeptal access, 38.1% administered heparin before transeptal puncture, while protamine was rarely or never used by 62.1%. Anticoagulation was partially interrupted in 52.1% and continued uninterrupted in 41.1% of routine atrial fibrillation (AF) ablations. The median bed rest duration post-procedure ranged from 4 h (right-sided EP procedures) to 6 h (AF or left-sided EP procedures). The average quoted vascular complication risk during consent was 3% (inter-quartile range 1-5%).

Conclusion: This survey highlights marked variation in vascular access site management during and following EP procedures, emphasizing the need for further clinical trials to inform best practice and guide future standardization efforts.

Keywords: Catheter ablation; Complications; Electrophysiology; Haemostasis; Vascular access.

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Conflict of interest statement

Conflict of interest: D.G. has received institutional research grants from Boston Scientific and Medtronic and speaker fees from Boston Scientific. V.L. has received institutional research grants from J&J MedTech and speaker fees for Boston Scientific and J&J MedTech. M.M.Z. has received lecture fees/honoraria and travel support by Medtronic, Boston Scientific, Bayer Vital, Pfizer, Abbott, ZOLL CMS, and AstraZeneca. P.F. holds patents related to high-voltage and bipolar ablation and equity in CorSystem. C.-H.H. has received travel grants and research grants from Boston Scientific, LifTech, Biosense Webster, and Haemonetics and speaker honoraria from Boston Scientific, Biosense Webster, Pfizer, Haemonetics, BMS, and C.T.I. GmbH and Doctrina Med. A.M. is a consultant for and has received honoraria from Abbott, Medtronic, Boston Scientific, and Biosense Webster. J.K.R.C. is a consultant for and has received honoraria/research funding from Abbott, Medtronic, Boston Scientific, and Biosense Webster. The other authors report no conflicts of interest. No funding was received towards this work.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Demographics of respondents. (A) Professional category of respondents. (B) Number of EP procedures in the preceding 12 months. (C) Country of work of respondents (created with MapChart.net). EP, electrophysiology.
Figure 2
Figure 2
Vascular access. (A) Use of ultrasound. (B) Availability of ultrasound during an EP procedure. (C) Training in ultrasound-guided access. (D) Healthcare professional gaining vascular access. (E) Vascular access sites used in the preceding 12 months. EP, electrophysiology; PA: physician associate.
Figure 3
Figure 3
Vascular haemostasis and closure. (A) Existence of standardized institutional policy on vascular haemostasis or closure. (B) Most commonly used vascular haemostasis technique. (C) Use of suture-based haemostasis techniques. (D) Use of VCDs. (E) Opinion on VCDs. VCDs, vascular closure devices.
Figure 4
Figure 4
Management of periprocedural anticoagulation. (A) Timing of heparin administration. (B) Use of protamine. (C) Periprocedural oral anticoagulation management.
Figure 5
Figure 5
Importance of factors in reducing vascular access site complications. Median, inter-quartile range. EP, electrophysiology; VCDs, vascular closure devices.
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