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Krimphoff A, Urbanek L, Bordignon S, Schaack D, Tohoku S, Chen S, Chun KRJ, Schmidt B. The impact of ultrasound-guided vascular access for catheter ablation of left atrial arrhythmias in a high-volume centre. J Interv Card Electrophysiol 2024; 67:1247-1255. [PMID: 38573537 PMCID: PMC11289139 DOI: 10.1007/s10840-024-01779-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies indicate that the utilization of ultrasound (US)-guided puncture may decrease the incidence of vascular complications; however, its routine use is not established in many centres. METHODS Patients undergoing catheter ablation for atrial fibrillation were included sequentially. All patients receiving US-guided punctures were prospectively enrolled (US group), while patients who underwent the procedure with standard puncture technique served as control group (No-US group). Periprocedural vascular complications requiring intervention within 30 days of the procedure were defined as the primary endpoint. RESULTS A total of 599 patients (average age: 69 ± 11 years, 62.9% male) were analysed. The incidence of vascular complications was lower with the US-guided puncture than with the anatomic landmark-guided puncture (14/299 [4.7%] vs. 27/300 [9%], p = 0.036). The US-guided vascular access significantly reduced the rate of false aneurysms (3/299 [1%] vs. 12/300 [4%], p = 0.019). In addition, the occurrence of arteriovenous fistula (2/299 [0.7%] vs. 4/300 [1.3%], p = 0.686) and haematoma requiring treatment (9/299 [3%] vs. 11/300 [3.7%], p = 0.655) were also lower in the US group. US-guided puncture did not prolong the procedure time (mean procedure time: 57.48 ± 24.47 min vs. 56.09 ± 23.36 min, p = 0.478). Multivariate regression analysis identified female gender (OR 2.079, CI 95% 1.096-3.945, p = 0.025) and conventional vascular access (OR 2.079, CI 95% 1.025-3.908, p = 0.042) as predictors of vascular complications. CONCLUSIONS The implementation of US-guided vascular access for left atrial catheter ablation resulted in a significant decrease of the overall vascular complication rate.
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Affiliation(s)
- Amelie Krimphoff
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus Krankenhaus, Goethe Universität, Wilhelm-Epstein Str. 4, 60431, Frankfurt/Main, Germany.
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Ding WY, Khanra D, Kozhuharov N, Shaw M, Luther V, Ashrafi R, Borbas Z, Mahida S, Modi S, Hall M, Snowdon R, Waktare J, Todd D, Gupta D. Incidence of vascular complications for electrophysiology procedures in the ultrasound era: a single-centre experience over 10,000 procedures in the long term. J Interv Card Electrophysiol 2022; 66:693-700. [PMID: 36214805 DOI: 10.1007/s10840-022-01386-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ultrasound (US) is being increasingly used to guide vascular access for electrophysiology (EP) procedures in many centres. Nonetheless, the incidence and predictors of vascular complications in the US era are limited. In this study, we describe our experience of vascular access-related complications associated with EP procedures which were performed with the routine use of US-guided vascular access. METHODS A total of 10,158 consecutive EP procedures in 8361 patients performed from April 2014 (when our centre moved to a policy of routine US-guided vascular access for EP procedures) to March 2022 were included. The outcome of interest was any vascular access-related complication that occurred within 7 days of the procedure; these were classified as severe if surgical intervention and/or blood transfusion was required, major if non-surgical intervention or delayed hospital discharge was required, or minor if it did not fulfil the criteria for severe or major. RESULTS During the study period, 2 (0.02%) severe vascular complications occurred, including 1 pseudo-aneurysm requiring surgery and 1 retroperitoneal haemorrhage requiring blood transfusion. Nine (0.09%) major complications occurred, including 6 hematomas managed by compression devices, 1 type B aortic dissection, 1 AV fistula managed conservatively and 1 haematoma managed conservatively but delayed hospital discharge. Eighteen (0.18%) minor haematomas were seen that did not require any intervention or delayed hospital discharge. On multivariable analysis, female sex [OR (95% CI): 2.5 (1.2, 5.4)] and use of an arterial access [OR (95% CI): 19.3 (7.1, 52.3)] were seen to be independent predictors of the 29 vascular complications. CONCLUSION With the use of US-guided vascular access in EP procedures, major vascular complications are exceedingly rare, particularly those needing surgical intervention. Our results provide additional evidence for scientific guidelines to support US use.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | | | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Reza Ashrafi
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Simon Modi
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Mark Hall
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Derick Todd
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
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Hoffmann E, Straube F, Wegscheider K, Kuniss M, Andresen D, Wu LQ, Tebbenjohanns J, Noelker G, Tilz RR, Chun JKR, Franke A, Stellbrink C, Garcia-Alberola A, Dorwarth U, Metzner A, Ouarrak T, Brachmann J, Kuck KH, Senges J. Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation. Europace 2020; 21:1313-1324. [PMID: 31199860 PMCID: PMC6735953 DOI: 10.1093/europace/euz155] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
Aims To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was ‘atrial arrhythmia recurrence’, secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70–1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64–0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26–1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34–0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48–0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.
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Affiliation(s)
- Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Dietrich Andresen
- Department of Cardiology at Evangelisches Krankenhaus Hubertus, Paul Gerhardt Diakonie gAG, Berlin, Germany
| | - Li-Qun Wu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jürgen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I - Kardiologie, Hildesheim, Germany
| | - Georg Noelker
- Department of Cardiology, Herz-und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.,Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - Andreas Franke
- Department of Cardiology, KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover, Germany
| | | | - Arcadi Garcia-Alberola
- Department of Cardiology, University Hospital Virgen de la Arrixaca, El-Palmar, Murcia, Spain
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Taoufik Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Jochen Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
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Kupó P, Pap R, Sághy L, Tényi D, Bálint A, Debreceni D, Basu-Ray I, Komócsi A. Ultrasound guidance for femoral venous access in electrophysiology procedures-systematic review and meta-analysis. J Interv Card Electrophysiol 2020; 59:407-414. [PMID: 31823233 PMCID: PMC7591449 DOI: 10.1007/s10840-019-00683-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. METHODS Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). RESULTS Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = - 92.1 s, 95% CI, - 142.12 - - 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). CONCLUSION Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.
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Affiliation(s)
- Péter Kupó
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary.
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary.
| | - Róbert Pap
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - László Sághy
- Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary
| | - Dalma Tényi
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Bálint
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
| | - Dorottya Debreceni
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
| | - Indranill Basu-Ray
- St. Francis Hospital, Memphis, TN, USA
- All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India
| | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary
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Apte NM, Shrestha A, Dendi R. Techniques to Avoid Complications of Atrial Fibrillation Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gautam S. Primum Non Nocere. JACC Clin Electrophysiol 2020; 6:125-126. [DOI: 10.1016/j.jacep.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
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Bode K. Transfemoral vascular access in electrophysiology: should we exclusively rely on ultrasound guidance? Europace 2019; 21:361-362. [PMID: 30010748 DOI: 10.1093/europace/euy167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Centre Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
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