Impact of venous closure systems on time to ambulation and discharge following AF ablation: a systematic review and meta-analytic review.

BACKGROUND

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.

METHOD

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.

RESULT

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).

CONCLUSION

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.