Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias
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Published on: May 26, 2015
Leonie Foerschner1, Nico Erhard1, Stephan Dorfmeister1
1Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstr. 36, 80636 Munich, Germany.
Insights
Ultrasound-guided vascular puncture (UGVP) significantly reduces vascular access complications during catheter ablation. Patients with a BMI over 30 kg/m² particularly benefit from this technique, experiencing fewer hematomas and pseudoaneurysms.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Surgery
Background:
- Standard femoral vascular access methods face challenges in patients with peripheral artery disease and obesity.
- Catheter ablation procedures for cardiac arrhythmias require reliable femoral access.
- Minimizing vascular complications is crucial for patient safety during these interventions.
Purpose of the Study:
- To evaluate the impact of ultrasound-guided vascular puncture (UGVP) on reducing vascular complications during catheter ablation.
- To compare complication rates between UGVP and conventional landmark-guided femoral access.
- To assess the effectiveness of UGVP in specific patient subgroups, including those with obesity (BMI > 30 kg/m²).
Main Methods:
- A retrospective analysis of 479 patients undergoing catheter ablation for atrial or ventricular arrhythmias.
- Comparison of vascular access complications between patients who underwent UGVP (n=320) and those who had a conventional approach (n=159).
- Subgroup analysis based on Body Mass Index (BMI), comparing patients with BMI > 30 kg/m² and BMI < 30 kg/m².
Main Results:
- Overall vascular access complication rate was 7.7% (37/479).
- UGVP showed a trend towards fewer total complications (6.3% vs. 10.7%) compared to the conventional approach.
- UGVP significantly reduced the risk of hematoma > 5 cm and pseudoaneurysm formation.
- In patients with BMI > 30 kg/m², UGVP markedly decreased the risk of total vascular access complications, large hematomas, and pseudoaneurysms.
Conclusions:
- Ultrasound-guided vascular puncture is an effective method for reducing vascular access complications in patients undergoing catheter ablation.
- UGVP offers significant benefits for patients with obesity (BMI > 30 kg/m²), improving procedural safety.
- The adoption of UGVP can enhance patient outcomes and potentially reduce healthcare costs associated with managing vascular complications.
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.
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