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