Mills Mark T, Gupta Dhiraj, Luther Vishal, Zylla Maura M, Futyma Piotr, Perrotta Laura, Mazurek Michal, Heeger Christian-Hendrick, Marcantoni Lina, Metzner Andreas, Chun Julian K R
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, William Henry Duncan Building, West Derby Street, Liverpool L7 8XL, UK.
Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
Europace. 2025 Jul 1;27(7). doi: 10.1093/europace/euaf117.
Reliable vascular access and haemostasis techniques are important to the safety of electrophysiology (EP) procedures. This European Heart Rhythm Association (EHRA) survey aimed to evaluate contemporary vascular access site management practices across international EP centres.
A 30-question survey was disseminated via the EHRA between March and April 2025, with 401 responses from professionals across 51 countries. Most respondents were cardiology consultants/attendings (82.0%), with 57.3% performing over 150 EP procedures annually. Ultrasound guidance for vascular access was usually or always used by 71.7%, though 21.4% used it rarely or never, and only 17.3% had received formal ultrasound training. Institutional protocols for haemostasis were lacking in around half (46.8%) of centres. Suture-mediated closure was the most common method for haemostasis (60.4%), followed by manual compression (33.0%) and vascular closure devices (VCDs, 5.8%). The figure-of-eight suture with a hand-tied knot was the most frequently used suture technique (79.7%). Just over a third (36.0%) had experience with VCDs, typically reserved for high-risk cases. For procedures requiring transeptal access, 38.1% administered heparin before transeptal puncture, while protamine was rarely or never used by 62.1%. Anticoagulation was partially interrupted in 52.1% and continued uninterrupted in 41.1% of routine atrial fibrillation (AF) ablations. The median bed rest duration post-procedure ranged from 4 h (right-sided EP procedures) to 6 h (AF or left-sided EP procedures). The average quoted vascular complication risk during consent was 3% (inter-quartile range 1-5%).
This survey highlights marked variation in vascular access site management during and following EP procedures, emphasizing the need for further clinical trials to inform best practice and guide future standardization efforts.
可靠的血管通路和止血技术对电生理（EP）手术的安全性至关重要。这项欧洲心律协会（EHRA）调查旨在评估国际EP中心当前的血管通路部位管理实践。
2025年3月至4月期间通过EHRA开展了一项包含30个问题的调查，来自51个国家的专业人员共提交了401份回复。大多数受访者是心脏病学顾问/主治医师（82.0%），其中57.3%的人每年进行超过150例EP手术。71.7%的人通常或总是使用超声引导进行血管穿刺，不过21.4%的人很少或从不使用，只有17.3%的人接受过正规的超声培训。约一半（46.8%）的中心缺乏止血的机构规范。缝合介导闭合是最常用的止血方法（60.4%），其次是手动压迫（33.0%）和血管闭合装置（VCDs，5.8%）。用手打结的8字缝合是最常用的缝合技术（79.7%）。略多于三分之一（36.0%）的人有使用VCDs的经验，VCDs通常用于高风险病例。对于需要经房间隔穿刺的手术，38.1%的人在经房间隔穿刺前给予肝素，而62.1%的人很少或从不使用鱼精蛋白。在52.1%的常规心房颤动（AF）消融术中，抗凝治疗被部分中断，在41.1%的病例中抗凝治疗持续未中断。术后卧床休息的中位时长从4小时（右侧EP手术）到6小时（AF或左侧EP手术）不等。在告知患者的血管并发症风险中，平均估计值为3%（四分位间距1 - 5%）。
这项调查突出了EP手术期间及术后血管通路部位管理存在显著差异，强调需要进一步开展临床试验，以明确最佳实践并指导未来的标准化工作。
