Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures

Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture-based techniques such as a figure-of-eight suture secured with a hand-tied knot (Fo8_HT) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8_MOD). We hypothesised that short-term bleeding outcomes using the Fo8_MOD approach would be superior to MC. We additionally compared outcomes between Fo8_MOD and Fo8_HT approaches.

We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8_HT and Fo8_MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression).

1089 patients were included: MC 718 (65.9%); Fo8_HT 105 (9.6%); Fo8_MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re-entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8_MOD associated with fewer complications than MC or Fo8_HT (major: MC 2.2%, Fo8_HT 6.0%, Fo8_MOD 0.8%, p = .01; minor: MC 16.5%, Fo8_HT 12.0%, Fo8_MOD 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8_MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17-0.48], p < .001), whilst intraprocedural heparinisation (OR 5.25 [2.88-9.69], p < .001) and larger maximal sheath size (OR 1.06 [1.00-1.11], p = .04) were associated with a higher risk of complications.

Femoral haemostasis with Fo8_MOD associates with fewer access site complications than MC and Fo8_HT following EP procedures that need periprocedural anticoagulation.