Suture‐based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures.

Background and aims: Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture‐based techniques such as a figure‐of‐eight suture secured with a hand‐tied knot (Fo8HT) or a modified figure‐of‐eight suture secured with a 3‐way stopcock (Fo8MOD). We hypothesised that short‐term bleeding outcomes using the Fo8MOD approach would be superior to MC. We additionally compared outcomes between Fo8MOD and Fo8HT approaches. Methods: We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8HT and Fo8MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression). Results: 1089 patients were included: MC 718 (65.9%); Fo8HT 105 (9.6%); Fo8MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re‐entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8MOD associated with fewer complications than MC or Fo8HT (major: MC 2.2%, Fo8HT 6.0%, Fo8MOD 0.8%, p =.01; minor: MC 16.5%, Fo8HT 12.0%, Fo8MOD 7.4%, p =.002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p =.729 for between groups rates). On multivariable logistic regression, Fo8MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17–0.48], p <.001), whilst intraprocedural heparinisation (OR 5.25 [2.88–9.69], p <.001) and larger maximal sheath size (OR 1.06 [1.00–1.11], p =.04) were associated with a higher risk of complications. Conclusion: Femoral haemostasis with Fo8MOD associates with fewer access site complications than MC and Fo8HT following EP procedures that need periprocedural anticoagulation. [ABSTRACT FROM AUTHOR]