Department of Electrophysiology, INOVA Heart and Vascular Institute, INOVA Fairfax Hospital, Fairfax, Virginia.
Department of Electrophysiology, Colorado Heart & Vascular, Lakewood, Colorado.
J Cardiovasc Electrophysiol. 2019 Dec;30(12):2806-2810. doi: 10.1111/jce.14252. Epub 2019 Nov 14.
Cryoballoon ablation is commonly used to treat atrial fibrillation (AF). Femoral vein hemostasis after cryoballoon ablation for AF is routinely achieved with manual pressure (MP) after reversal of heparin and reassessment of the activated clotting time, or with a figure-of-eight suture (F8). The purpose of this randomized trial was to compare these two techniques for femoral vein hemostasis after cryoballoon ablation for AF in a patient population predominantly on novel anticoagulants (NOAC).
Seventy consecutive patients who underwent cryoballoon ablation were randomized to either the MP or F8 for femoral vein hemostasis. Clinical and procedural characteristics were similar between the groups with the majority of patients treated with a NOAC. The total time in the electrophysiology laboratory for the MP group and the F8 group (197 ± 37 minutes vs 167 ± 36 minutes, respectively; P = .02), and the time from sheath removal until the patient left the laboratory (28 ± 9 minutes vs 20 ± 5 minutes, respectively; P < .0001) were significantly less in the F8 group. Additional pressure for hemostasis in the recovery suite was required more often in the MP Group, as opposed to the F8 group (29% vs 3%; P = .003). No major bleeding occurred and the rate of minor hematomas was statistically similar.
Hemostasis obtained with a F8 suture after cryoballoon ablation for AF is associated with significantly less patient time in the electrophysiology laboratory, and an improved safety profile, compared with manual hemostasis, even amongst patients treated with a NOAC.
冷冻球囊消融术常用于治疗心房颤动（AF）。在逆转肝素并重新评估激活凝血时间后，或使用八字形缝线（F8），通常采用手动压迫（MP）来实现 AF 冷冻球囊消融后的股静脉止血。本随机试验的目的是比较这两种技术在新型抗凝剂（NOAC）患者人群中用于 AF 冷冻球囊消融后的股静脉止血。
连续 70 例接受冷冻球囊消融的患者被随机分为 MP 或 F8 组进行股静脉止血。两组的临床和程序特征相似，大多数患者接受了 NOAC 治疗。MP 组和 F8 组在电生理实验室的总时间（分别为 197±37 分钟和 167±36 分钟；P=0.02）和从鞘管拔出到患者离开实验室的时间（分别为 28±9 分钟和 20±5 分钟；P<0.0001）显著更短。与 F8 组相比，在恢复室中需要更多的额外压力来止血（MP 组 29%，F8 组 3%；P=0.003）。没有发生主要出血，小血肿的发生率统计学上相似。
与 MP 相比，即使在接受 NOAC 治疗的患者中，AF 冷冻球囊消融后使用 F8 缝线止血与患者在电生理实验室中的时间明显减少，且安全性更好。
