Ultrasound-Guided Vascular Access Procedure Associated with Fewer Complications in Patients with Atrial Fibrillation

Retrospective analysis of ablation outcomes before and after a medical center began using ultrasound to guide vascular access indicates that the technology significantly reduces complications.

Investigators gathered outcome data on 689 consecutive patients who underwent 720 ablation procedures at Virginia Commonwealth University Medical Center. A total of 357 procedures took place before June, 2015, when surgeons there began using ultrasound-guided vascular access on all patients. The remaining 363 took place afterward after the transition. Nearly half of all the patients (48%) underwent ablation to treat atrial fibrillation (AF).

Overall, 19 of the procedures that were not guided by ultrasound (5.3%) resulted in some sort of complication compared to 4 of the ultrasound-guided ablations (1.1%). Analysis showed this to be a significant difference (p = 0.002). Major complications were also more common in surgeries that were not guided by ultrasound (9 [2.5%] vs 2 [0.6%]; p = 0.03].

“In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, ultrasound guided vascular access was associated with a significantly decreased 30-day risk of vascular complications,” the study authors wrote in the Journal of Cardiovascular Electrophysiology.

The conclusions of the new study echo those of another evaluation of ultrasound guidance that appeared in the Journal of the American College of Cardiology a few months ago.

The authors of that paper retrospectively studied 511 patients who underwent venous-access ablations for AF. All of the patients remained on uninterrupted anticoagulation throughout the surgery. The 357 patients whose surgeons used landmarks to guide them were slightly older than the 154 whose surgeons used ultrasound, but there were no significant differences between the 2 groups in sex, body mass index, or anticoagulation therapy.

The success rate was 100% for both groups and the procedure time did not vary significantly. Clinically significant bleeding (groin hematomas or prolonged bleeding) occurred in 3.4 % of patients with landmark-guided access vs 0 % of those with US-guided access (odds ratio [OR], 11; Fisher’s exact test P = 0.02).

“Compared with the landmark-guided approach, US-guided femoral vein access in patients undergoing AF ablation with uninterrupted anticoagulation did not lead to increased procedural times while reducing the incidence of groin hematoma and bleeding,” the study authors wrote.

An earlier study that appeared in the Journal of Cardiovascular Electrophysiology also found significant benefits to using ultrasound-guided access.

Investigators assigned 209 consecutive AF patients to ultrasound or standard care and compared outcomes a few days after surgery and a full month later. Outcome measures were pain, significant bleeding, and prolonged bruising.

Analysis of medical records and questionnaires returned by patients indicated that ultrasound patients were significantly less likely to have a BARC 2+ bleed (10.4% vs 19.9% of standard patients; p = 0.02), less likely to suffer groin pain after discharge (27.1% vs. 42.8%; p = 0.006) and less likely to experience prolonged local bruising (21.5% vs. 40.4%; p = 0.001).

“Routine use of ultrasound-guided vascular access for AFA is associated with a significant reduction in bleeding complications, post-procedural pain, and prolonged bruising when compared to standard care,” the authors of that study wrote.