Shafique Muhammad Ashir, Nagra Hira Mustafa, Farooq Aisha, Ahmad Sajal, Gardezi Syed Muhammad Fahad, Faisal Usman, Anees Muhammad Hamza, Muhammad Haris Hafiz, Moradi Iman, Fredericks Mathew, Dar Hassaan, Shojai Rahnama Behrooz, Khan Sher Ali, Khalid Saif, Iqbal Javed, Devi Janta
Jinnah Sindh Medical University, Karachi, Pakistan.
Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan.
Egypt Heart J. 2025 Sep 15;77(1):88. doi: 10.1186/s43044-025-00685-5.
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, significantly impacting global health and healthcare costs. Pulmonary vein isolation (PVI) is the preferred method for catheter-based AF ablation, reducing arrhythmia recurrence. However, vascular access complications remain a concern. This systematic review and meta-analysis aimed to compare the efficacy and safety of venous closure systems (VCSs), like Perclose™ ProGlide™, with traditional manual compression (MC) techniques, focusing on time to hemostasis (TTH), time to ambulation in hours (TTA), time to discharge (TTD), and complication rates.
A comprehensive search was conducted in PubMed, Medline, Scopus, and Embase, adhering to PRISMA guidelines. Five studies met the inclusion criteria, comprising randomized controlled trials (RCTs) and observational studies. Data were analyzed using OpenMeta, applying a random-effects model to calculate standardized mean differences (SMDs) and odds ratios (ORs). Heterogeneity was assessed using the I statistic, and funnel plots evaluated publication bias.
The meta-analysis included 5 studies with a total of 240 patients. VCSs significantly reduced TTA (SMD - 2.029, 95% CI - 3.097 to - 0.962, p = 0.001) and TTD (SMD - 2.081, 95% CI - 3.870 to - 0.292, p = 0.023) compared to MC, but showed no significant reduction in TTH (SMD - 1.109, 95% CI - 2.524 to 0.307, p = 0.125). No significant differences were observed in bleeding complications (OR 1.35, 95% CI 0.413 to 4.125, p = 0.604) or hematoma rates (OR 4.665, 95% CI 0.768 to 28.345, p = 0.094).
VCSs demonstrated faster ambulation and discharge times compared to MC techniques, suggesting potential benefits in improving patient flow and satisfaction. However, the slight increase in hematoma risk warrants further investigation. These findings could guide clinical decision-making in vascular access management post-AF ablation.
心房颤动（AF）是最常见的持续性心律失常，对全球健康和医疗成本有重大影响。肺静脉隔离（PVI）是基于导管的房颤消融的首选方法，可降低心律失常复发率。然而，血管通路并发症仍然是一个问题。本系统评价和荟萃分析旨在比较静脉闭合系统（VCSs），如Perclose™ ProGlide™，与传统手动压迫（MC）技术的有效性和安全性，重点关注止血时间（TTH）、下床活动时间（TTA）、出院时间（TTD）和并发症发生率。
按照PRISMA指南，在PubMed、Medline、Scopus和Embase中进行了全面检索。五项研究符合纳入标准，包括随机对照试验（RCTs）和观察性研究。使用OpenMeta分析数据，应用随机效应模型计算标准化平均差（SMDs）和比值比（ORs）。使用I统计量评估异质性，漏斗图评估发表偏倚。
荟萃分析纳入了5项研究，共240例患者。与MC相比，VCSs显著缩短了TTA（SMD -2.029，95%CI -3.097至-0.962，p = 0.001）和TTD（SMD -2.081，95%CI -3.870至-0.292，p = 0.023），但TTH没有显著缩短（SMD -1.109，95%CI -2.524至0.307，p = 0.125）。在出血并发症（OR 1.35，95%CI 0.413至4.125，p = 0.604）或血肿发生率（OR 4.665，95%CI 0.768至28.345，p = 0.094）方面未观察到显著差异。
与MC技术相比，VCSs显示出更快的下床活动和出院时间，表明在改善患者流程和满意度方面具有潜在益处。然而，血肿风险的轻微增加值得进一步研究。这些发现可为房颤消融术后血管通路管理的临床决策提供指导。
