Suture-based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures.

BACKGROUND AND AIMS

Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture-based techniques such as a figure-of-eight suture secured with a hand-tied knot (Fo8) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8). We hypothesised that short-term bleeding outcomes using the Fo8 approach would be superior to MC. We additionally compared outcomes between Fo8 and Fo8 approaches.

METHODS

We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8 and Fo8. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression).

RESULTS

1089 patients were included: MC 718 (65.9%); Fo8 105 (9.6%); Fo8 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re-entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8 associated with fewer complications than MC or Fo8 (major: MC 2.2%, Fo8 6.0%, Fo8 0.8%, p = .01; minor: MC 16.5%, Fo8 12.0%, Fo8 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8 was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17-0.48], p < .001), whilst intraprocedural heparinisation (OR 5.25 [2.88-9.69], p < .001) and larger maximal sheath size (OR 1.06 [1.00-1.11], p = .04) were associated with a higher risk of complications.

CONCLUSION

Femoral haemostasis with Fo8 associates with fewer access site complications than MC and Fo8 following EP procedures that need periprocedural anticoagulation.