Ultrasound (US) guided vascular access is increasingly used for invasive cardiac electrophysiology (EP) procedures in many centers for femoral vascular groin access. In this study, we describe our experience of vascular access-related complications associated with EP procedures which were performed in a two-year period with the routine use of anatomical landmarks vs. US-guided vascular access.

Methods 
A total of 1119 consecutive EP procedures in 1012 patients performed from 10th of September 2020 (one year prior to a policy of routine US-guided vascular access for EP procedures) to September 10th 2022 were included.

The endpoint consisted of any vascular access-related complication,  classified as hematoma, aneurysm or AV-fistula.

Risk factors including HASBLED Score, intraprocedural ACT, OAC, use of platelet aggregation inhibitors, age, diabetes mellitus and BMI were analyzed.

Results

During the study period, 776 procedures were performed using anatomical landmark guiding and 343 procedures using US-guided access. The procedures were performed for pulmonary vein isolation (PVI) (65,8%), ablation of atrial fibrillation other than PVI (12,9%), atrial tachycardia (12,2%) and atrial flutter (9,1%). Mean age at time of procedure was 67,2 years (range 20-93) with a mean body mass index of 27,1 (range 17-52).

Overall, 19 (1,7%) relevant vascular complications occurred meeting the above-mentioned criteria, including: 15 (1,3%) hematomas, 2 (0,18%) aneurysms and 2 (0,18%) AV-fistulas. 16 (2,1%) complications occurred in the group using landmark guided access and 3 (0,9%) in the US vascular access group.

Correlation analysis showed a negative correlation (R= -0,42; p=0,078) between US-access and vascular complications that showed a clear tendency towards a lower complication rate without reaching statistical significance due to the relatively low number of patients.

A significant correlation was demonstrated for the first intraprocedural ACT (range 174-320 sec; mean 256 sec, max. 320 sec) and number of vascular complications (spearman Rho R= -0,68; p=0,014) showing that a lower ACT was associated with a fewer complications. On multivariable analysis, only the HASBLED score [range 0-4; mean=1,47; maximum=4) was shown to be an independent predictor of the 19 vascular complications (OR  (95% CI, 0,28-0,738): 0,454; p= 0,001).

Analyzing the entire patient cohort, univariate analysis demonstrated that only HASBLED Score count and a higher first intraprocedural activated coagulation time (ACT) were associated with vascular complications. OAC, use of platelet aggregation inhibitors, BMI, diabetes mellitus, age at time of procedure and sex did not predict the number of complications.

Conclusion 

Even though adverse vascular events associated with EP procedures are generally rare, the use of US-guided vascular access further markedly reduces the number of complications. The use of US-vascular access is advisable as there is a constant availability of ultrasound devices.