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Ultrasound Guided Vascular Access for Electrophysiologic Procedures Introduction Vascular access related complications are the most common complications from catheter based EP procedures and have been reported to occur in 1-13% of cases. We prospectively assessed vascular complications in a large series of consecutive patients undergoing catheter based electrophysiologic (EP) procedures with ultrasound (US) guided vascular access versus conventional access. Methods and Results Consecutive patients undergoing catheter ablation procedures at VCU medical center were included. US guided access was obtained in all cases starting June 2015 (US group) while modified Seldinger technique without US guidance (non-US group) was used in cases prior to this date. All vascular complications were recorded for a 30-day period after the procedure. A total of 689 patients underwent 720 procedures. Ablations for ventricular tachyarrhythmias (ventricular tachycardia: VT, premature ventricular contractions: PVCs) accounted for 89 (12%) cases; atrial fibrillation (AF) ablations accounted for 328 procedures (46%) and other catheter based procedures accounted for 42% of cases. A significantly higher incidence of complications was noted in the non-US group compared with the US group (19 [5.3%] vs. 4 [1.1%], respectively, P = 0.002). Major complications were also higher among the non-US group (9 [2.5%] vs. 2 [0.6%], P = 0.03). Increasing age (P = 0.04) and non-US guided vascular access (P = 0.002) were associated with a higher risk of vascular access complications. Conclusion In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, US guided vascular access was associated with a significantly decreased 30-day risk of vascular complications. [ABSTRACT FROM AUTHOR]

Introduction: Cryoballoon ablation is commonly used to treat atrial fibrillation (AF). Femoral vein hemostasis after cryoballoon ablation for AF is routinely achieved with manual pressure (MP) after reversal of heparin and reassessment of the activated clotting time, or with a figure-of-eight suture (F8). The purpose of this randomized trial was to compare these two techniques for femoral vein hemostasis after cryoballoon ablation for AF in a patient population predominantly on novel anticoagulants (NOAC)., Methods and Results: Seventy consecutive patients who underwent cryoballoon ablation were randomized to either the MP or F8 for femoral vein hemostasis. Clinical and procedural characteristics were similar between the groups with the majority of patients treated with a NOAC. The total time in the electrophysiology laboratory for the MP group and the F8 group (197 ± 37 minutes vs 167 ± 36 minutes, respectively; P = .02), and the time from sheath removal until the patient left the laboratory (28 ± 9 minutes vs 20 ± 5 minutes, respectively; P < .0001) were significantly less in the F8 group. Additional pressure for hemostasis in the recovery suite was required more often in the MP Group, as opposed to the F8 group (29% vs 3%; P = .003). No major bleeding occurred and the rate of minor hematomas was statistically similar., Conclusions: Hemostasis obtained with a F8 suture after cryoballoon ablation for AF is associated with significantly less patient time in the electrophysiology laboratory, and an improved safety profile, compared with manual hemostasis, even amongst patients treated with a NOAC., (© 2019 Wiley Periodicals, Inc.)