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Gupta S, Kolluri R, Simoes T, Pingle SC, Nie H, Lloyd MS, Steinhaus D, Westerman SB, Shah A, Kline J, Kiani S. Safety of multi-access site venous closure following catheter ablation of atrial fibrillation and flutter. J Interv Card Electrophysiol 2024; 67:1437-1443. [PMID: 38413483 PMCID: PMC11379729 DOI: 10.1007/s10840-024-01773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Following catheter ablation, vascular access management involves potential complications and prolonged recovery. Recently, suture-mediated closure (SMC) devices were approved for venous access procedures. The objective of this study is to evaluate the safety of a commercially available SMC for multiple access site venous closure by duplex ultrasound (DUS) in asymptomatic subjects with non-visible complications. METHODS Thirty-six subjects (63 ± 10.7 years old, 12 female) were enrolled. Following catheter ablation for atrial fibrillation, all subjects had SMC of every venous access site. Subjects underwent DUS of femoral veins and arteries. DUS was performed at discharge, and again at 30 days. Subjects were evaluated for clinically apparent vascular complications. RESULTS Mean procedure duration was 138.6 min, and the time to hemostasis was 3.1 min/access site and 9.5 min/subject. Median time to ambulation was 193.5 min, and median time to discharge was 5.95 h, with discharge as early as 2.4 h. A median of 2 sheaths/vein and a median of 2 SMC devices/vein were used. There were no major complications and a 16.7% (6/36) minor complication rate at discharge. All complications resolved at 30 days. The complication rate was not higher in patients with 2 SMC per access site as compared to the patients who just received 1 SMC per access site. CONCLUSIONS This study demonstrates the safety of multi-access closure using SMC, following catheter ablation procedures, for closure of sites that use sheath sizes from ≤ 8F to ≥ 15F and for those that use 2 or more SMCs per access site.
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Affiliation(s)
- Sanjaya Gupta
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA.
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
| | | | | | | | - Hong Nie
- Abbott Vascular, Santa Clara, CA, USA
| | | | - Daniel Steinhaus
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Anand Shah
- Division of Cardiology, Emory University, Atlanta, GA, USA
| | - Jessica Kline
- Division of Cardiology, Saint Luke's Mid-America Heart Institute, 9th Floor, Cardiovascular Research, Kansas City, MO, 64111, USA
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Soroosh Kiani
- Division of Cardiology, Emory University, Atlanta, GA, USA
- Division of Cardiovascular Medicine, UMass Chan Medical School, Worcester, MA, USA
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Jiang Z, Guo C, Liu Q, Tian Y, Tian L, Yang Y, Wang J, Chen C, Zheng Y, Li Y, Ou Q, Yang L. Outcomes of single-procedure radiofrequency catheter ablation for idiopathic ventricular arrhythmias: a single-centre retrospective cohort study. BMJ Open 2024; 14:e081815. [PMID: 38382956 PMCID: PMC10882318 DOI: 10.1136/bmjopen-2023-081815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference. DESIGN Retrospective cohort study. SETTING Patient data were collected from a tertiary hospital in Guizhou, China. PARTICIPANTS Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled. OUTCOME MEASURES Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified. RESULTS The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence. CONCLUSIONS Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.
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Affiliation(s)
- Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chuxian Guo
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qifang Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ye Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ying Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Junxian Wang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chunyan Chen
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yaxi Zheng
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yu Li
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qiaoqiao Ou
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Long Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
- Guizhou Medical University, Guiyang, Guizhou, China
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Aguilera J, Hutt E, Madden R, Kanj M, Saliba W, Rickard J, Sroubek J, Callahan T, Chung M, Baranowski B, Martin D, Dresing T, Wazni OM, Hussein A, Cantillon D, Patel D, Nakhla S, Taigen T. Same-day discharge after atrial fibrillation ablation. Heliyon 2023; 9:e22178. [PMID: 38045193 PMCID: PMC10692798 DOI: 10.1016/j.heliyon.2023.e22178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 10/20/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Atrial fibrillation (AF) catheter ablation has become an increasingly effective and safe strategy for the management of AF. With increased safety of catheter ablation, same-day discharge (SDD) is a potential way to minimize health care resource utilization and improve patient experience. Objective To evaluate the safety and patient satisfaction of SDD after contemporary AF ablation. Methods Consecutive patient undergoing AF ablation at our institution between 1/2020 and 10/2021 were enrolled in registry for clinical, quality, procedural and outcomes data. Patients were considered for SDD per physician discretion and patients' preference based upon clinical evaluation. Adjudicated ninety-day major complications, thirty-day adverse events, and thirty-day re-admissions were collected in a prospective registry for all patients. Results A total of 2142 consecutive patients underwent elective AF ablation during the study period. After excluding cases with missing data, 1830 patients were included in the analysis. Of those, 350 (19 %) patients were discharged the same day (SDD group) and 1480 (81 %) stayed overnight. Patients in the SDD group compared to overnight stay group were younger, more likely to be male, White patients, lower CHA2DS2-VASc score and to be on lower rates of warfarin as an anticoagulation strategy. After propensity score matching, SDD was associated with lower rate of major complications and higher patient satisfaction. The majority of life-treating complications occurred interprocedurally or within 6 h of procedure termination. Conclusion The present study demonstrated that SDD after contemporary AF ablation is feasible, safe and associated with higher patient satisfaction using a proposed SDD pathway and criteria.
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Affiliation(s)
- Jose Aguilera
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Erika Hutt
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Ruth Madden
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Walid Saliba
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - John Rickard
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Jakub Sroubek
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Callahan
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mina Chung
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Baranowski
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - David Martin
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Dresing
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Oussama M. Wazni
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Cantillon
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Divyang Patel
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Shady Nakhla
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Taigen
- Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic, Cleveland, OH, USA
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Eldadah ZA, Al-Ahmad A, Bunch TJ, Delurgio DB, Doshi RN, Hook BG, Hranitzky PM, Joyner CA, Mittal S, Porterfield C, Sanchez JE, Thambidorai SK, Wazni OM, McElderry HT. Same-day discharge following catheter ablation and venous closure with VASCADE MVP: A postmarket registry. J Cardiovasc Electrophysiol 2023; 34:348-355. [PMID: 36448428 DOI: 10.1111/jce.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Early and safe ambulation can facilitate same-day discharge (SDD) following catheter ablation, which can reduce resource utilization and healthcare costs and improve patient satisfaction. This study evaluated procedure success and safety of the VASCADE MVP venous vascular closure system in patients with atrial fibrillation (AF). METHODS The AMBULATE SDD Registry is a two-stage series of postmarket studies in patients with paroxysmal or persistent AF undergoing catheter ablation followed by femoral venous access-site closure with VASCADE MVP. Efficacy endpoints included SDD success, defined as the proportion of patients discharged the same day who did not require next-day hospital intervention for procedure/access site-related complications, and access site sustained success within 15 days of the procedure. RESULTS Overall, 354 patients were included in the pooled study population, 151 (42.7%) treated for paroxysmal AF and 203 (57.3%) for persistent AF. SDD was achieved in 323 patients (91.2%) and, of these, 320 (99.1%) did not require subsequent hospital intervention based on all study performance outcomes. Nearly all patients (350 of 354; 98.9%) achieved total study success, with no subsequent hospital intervention required. No major access-site complications were recorded. Patients who had SDD were more likely to report procedure satisfaction than patients who stayed overnight. CONCLUSION In this study, 99.7% of patients achieving SDD required no additional hospital intervention for access site-related complications during follow-up. SDD appears feasible and safe for eligible patients after catheter ablation for paroxysmal or persistent AF in which the VASCADE MVP is used for venous access-site closure.
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Affiliation(s)
- Zayd A Eldadah
- Heart & Vascular Institute, MedStar Health, Columbia, Maryland, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Murray, Utah, USA
| | - David B Delurgio
- Department of Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Rahul N Doshi
- Cardiac Arrhythmia Group, HonorHealth Medical Group, Scottsdale, Arizona, USA
| | - Bruce G Hook
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | | | - Charles A Joyner
- Department of Cardiology, Levinson Heart Hospital at Chippenham and Johnston Willis Medical Center, Richmond, Virginia, USA
| | - Suneet Mittal
- Electrophysiology, Valley Health System, Ridgewood, New Jersey, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia, Medical City Dallas, Dallas, Texas, USA
| | | | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Thomas McElderry
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mohammed M, Ramirez R, Steinhaus DA, Yousuf OK, Giocondo MJ, Ramza BM, Wimmer AP, Gupta SK. Comparative outcomes of vascular access closure methods following atrial fibrillation/flutter catheter ablation: insights from VAscular Closure for Cardiac Ablation Registry. J Interv Card Electrophysiol 2021; 64:301-310. [PMID: 33796968 DOI: 10.1007/s10840-021-00981-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This registry compared the safety and efficacy of vascular closure device Perclose (PC) with figure-of-eight stitch (Fo8) and manual compression (MC) following catheter ablation of atrial fibrillation/flutter. METHODS VAscular Closure for Cardiac Ablation Registry (VACCAR) is a prospective, observational registry that assessed the time to hemostasis (TTH), time to ambulation (TTA), length of stay (LOS), complications, patient-reported outcomes, and pain medication use. RESULTS A total of 434 patients (mean age 64.0±11.0 years; 38% female; 94.9% white) were enrolled between October 2017 and May 2019: 156 in MC, 203 in Fo8, and 75 in the PC group. Median TTH was significantly reduced in the PC and Fo8 group at 7 and 9 min respectively vs. the MC group at 20 min (p<0.001). Median TTA was significantly reduced in both the PC and Fo8 group at 2.2 h vs. the MC group at 6.5 h (p<0.001 for both). Median LOS for the PC group was significantly reduced at 27.5 h compared to the MC and Fo8 group at 29 h (p<0.01). A higher proportion of same-day discharges were noted in the PC and Fo8 groups at 14 (18.7%) and 25 (12.3%), respectively, compared to 5 (3.2%) in the MC group (p<0.01 for all). There was no significant difference in complications between the three groups. CONCLUSIONS Both PC and Fo8 are safe with improved TTH, TTA, LOS, and a higher number of same-day discharges compared to MC.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Medicine, Saint Luke's Health System, Kansas City, MO, USA
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City, MO, USA
| | - Rigoberto Ramirez
- Division of Cardiology, The University of Kansas Hospital, Kansas City, KS, USA
| | - Daniel A Steinhaus
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Omair K Yousuf
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Michael J Giocondo
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Brian M Ramza
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Alan P Wimmer
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Sanjaya K Gupta
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
- University of Missouri Kansas City School of Medicine, 4401 Wornall Road, Kansas City, MO, 64111, USA.
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