Clinical introduction of ultrasound-guided vascular access in catheter ablation of left atrial arrhythmias

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Vascular complications are a common occurrence during atrial fibrillation ablation. Observational studies show that the incidence of vascular complications can be reduced by using ultrasound (US)-guided puncture, however its routine use is not established in many centers. PURPOSE: To compare the rate of vascular complications between ultrasound-guided and conventional anatomic landmark-guided vascular access during catheter ablation of left atrial arrhythmias. METHODS: Patients undergoing catheter ablation for atrial fibrillation were included sequentially. All patients receiving US-guided puncture were prospectively enrolled group A, while patients who underwent the procedure with standard puncture technique served as control group B. The primary endpoint were periprocedural vascular complications requiring intervention within 30 days of the procedure RESULTS: 599 patients (average age: 68 ± 11 years, 63,1% male) were analyzed, 299 in group A and 300 in group B. Demographic and clinical baseline characteristics were comparable between the two groups, except higher prevalence of pre-existing Diabetes mellitus in group A (14,7% vs. group B: 8,7%, p=0.022). The majority of patients were treated with radiofrequency ablation (51,5%), followed by pulsed-field ablation (20,4%) and cryoballoon (18,7%). Other ablation techniques were laserballoon and radiofrequency balloon ablation. The overall rate of vascular complications was lower with the ultrasound-guided puncture than the anatomic landmark-guided puncture (14/299 4,7% vs. 27/300 9%, p=0.036). The ultrasound-guided puncture resulted in a significantly reduced rate of false aneurysms (3/299 1% vs. 12/300 4%, p=0.019). In addition, arteriovenous fistula (2/0,7% vs. 4/1,3%, p=0.414) and hematoma requiring treatment (9/299 3% vs. 11/300 3,7%, p=0.655) were also lower in group A. CONCLUSION: The use of ultrasound-guided vascular access for catheter ablation resulted in a significant reduction of the overall vascular complication rate.