Sharma Parikshit S, Padala Santosh K, Gunda Sampath, Koneru Jayanthi N, Ellenbogen Kenneth A
Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
J Cardiovasc Electrophysiol. 2016 Oct;27(10):1160-1166. doi: 10.1111/jce.13042. Epub 2016 Aug 9.
Vascular access related complications are the most common complications from catheter based EP procedures and have been reported to occur in 1-13% of cases. We prospectively assessed vascular complications in a large series of consecutive patients undergoing catheter based electrophysiologic (EP) procedures with ultrasound (US) guided vascular access versus conventional access.
Consecutive patients undergoing catheter ablation procedures at VCU medical center were included. US guided access was obtained in all cases starting June 2015 (US group) while modified Seldinger technique without US guidance (non-US group) was used in cases prior to this date. All vascular complications were recorded for a 30-day period after the procedure. A total of 689 patients underwent 720 procedures. Ablations for ventricular tachyarrhythmias (ventricular tachycardia: VT, premature ventricular contractions: PVCs) accounted for 89 (12%) cases; atrial fibrillation (AF) ablations accounted for 328 procedures (46%) and other catheter based procedures accounted for 42% of cases. A significantly higher incidence of complications was noted in the non-US group compared with the US group (19 [5.3%] vs. 4 [1.1%], respectively, P = 0.002). Major complications were also higher among the non-US group (9 [2.5%] vs. 2 [0.6%], P = 0.03). Increasing age (P = 0.04) and non-US guided vascular access (P = 0.002) were associated with a higher risk of vascular access complications.
In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, US guided vascular access was associated with a significantly decreased 30-day risk of vascular complications.
血管通路相关并发症是基于导管的电生理（EP）手术最常见的并发症，据报道其发生率为1% - 13%。我们前瞻性评估了一大系列连续接受基于导管的电生理（EP）手术患者的血管并发症，这些患者分别采用超声（US）引导的血管通路与传统通路。
纳入弗吉尼亚联邦大学医学中心连续接受导管消融手术的患者。自2015年6月起所有病例均采用超声引导通路（超声组），在此之前的病例则采用无超声引导的改良Seldinger技术（非超声组）。术后30天记录所有血管并发症。共有689例患者接受了720例手术。室性快速心律失常（室性心动过速：VT，室性早搏：PVCs）消融术占89例（12%）；房颤（AF）消融术占328例（46%），其他基于导管的手术占42%。与超声组相比，非超声组并发症发生率显著更高（分别为19例[5.3%] vs. 4例[1.1%]，P = 0.002）。非超声组的主要并发症也更多（9例[2.5%] vs. 2例[0.6%]，P = 0.03）。年龄增加（P = 0.04）和非超声引导的血管通路（P = 0.002）与血管通路并发症风险较高相关。
在一大系列接受基于导管的心律失常EP手术的患者中，超声引导的血管通路与30天血管并发症风险显著降低相关。
