Value of ultrasound for access guidance and detection of subclinical vascular complications in the setting of atrial fibrillation cryoballoon ablation

Erwin Ströker, Carlo de Asmundis, Kaspars Kupics, Ken Takarada, Giacomo Mugnai, Jeroen De Cocker, Dirk Stockman, Erwin Ströker, Bruno Schwagten, Pedro Brugada, Yves De Greef, Gian Battista Chierchia

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims: Vascular complications are the most common complications of atrial fibrillation (AF) ablation. Cryoballoon (CB) ablation for AF needs the insertion of a large 15 Fr sheath in the femoral vein. Our aim was to investigate the impact of vascular ultrasound (US) in guiding access and evaluating post-procedural subclinical complications in a large, multi-centre patient cohort that underwent CB ablation.

Methods and results: A total cohort of 1435 consecutive patients were subdivided in 870 US -/-, 265 US -/+, and 300 US +/+ patients depending on US performance for: venipuncture guidance/post-procedural evaluation. Major clinical complications (requiring intervention and/or prolonged stay) were assessed. Irrespective of the clinical status, major US events were systematically determined in the subgroups with US evaluation 1 day post-procedure, if evidence of inadvertent artery puncture/cannulation (communication between artery and collection or artery-vein, regardless of the thrombosis state). Major clinical events were encountered in 1.7% (15/870), 1.1% (3/265), and 0% of patients in US -/-, US -/+, and US +/+ group, respectively (P = 0.02 between US -/- and US +/+ group). In the US -/- group, 5/10 (50%) of pseudo-aneurysms were diagnosed during readmission after a mean of 24 ± 11 days post-procedure. No delayed presentation was seen in the US -/+ group. Major US events during the US protocol post-procedure were seen in 3.8% (10/265) vs. 0.3% (1/300) of patients in US -/+ vs. US +/+ group, respectively, P = 0.004.

Conclusion: US-guided venipuncture was associated with a near-to-zero risk of vascular complications in our patients undergoing CB ablation.

Original languageEnglish
Pages (from-to)434-439
Number of pages6
JournalEuropace
Volume21
Issue number3
Early online date11 Jul 2018
DOIs
Publication statusPublished - 1 Mar 2019

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

Keywords

  • ultrasound
  • subclinical vascular complications
  • atrial fibrillation cryoballoon ablation
  • vascular complications
  • Atrial Fibrillation
  • Cryballoon

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