Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation
Introduction Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking....
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2024-08, Vol.35 (8), p.1656-1662 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Mills, Mark T. Calvert, Peter Lip, Gregory Y. H. Luther, Vishal Gupta, Dhiraj |
| description | Introduction
Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking.
Methods
Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation).
Results
After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p |
| doi_str_mv | 10.1111/jce.16345 |
| format | Article |
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Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking.
Methods
Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation).
Results
After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p < .001) and extended follow‐up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65–0.98; p = .032). This was driven by a lower rate of vascular complications during early follow‐up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52–0.83; p < .001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58–0.92; p = .007) and extended follow‐up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43–0.86; p = .005).
Conclusion
Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD.</description><identifier>ISSN: 1045-3873</identifier><identifier>ISSN: 1540-8167</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.16345</identifier><identifier>PMID: 38924288</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Aged ; atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Bleeding ; Blood transfusion ; Cardiac arrhythmia ; catheter ablation ; Catheter Ablation - adverse effects ; Catheterization, Peripheral - adverse effects ; Catheters ; Female ; Femoral Vein ; Femur ; Fibrillation ; Hemorrhage - etiology ; Hemorrhage - prevention & control ; Hemostasis ; Hemostatic Techniques - adverse effects ; Hemostatic Techniques - instrumentation ; Humans ; Male ; Middle Aged ; Patients ; Punctures ; Radiofrequency ablation ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; vascular closure device ; Vascular Closure Devices ; vascular injury</subject><ispartof>Journal of cardiovascular electrophysiology, 2024-08, Vol.35 (8), p.1656-1662</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC.</rights><rights>2024 The Author(s). Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3185-d283ecb531b33cfa1c912c58a8064713b3e146d9e4841a21bca3f459b3e9204c3</citedby><cites>FETCH-LOGICAL-c3185-d283ecb531b33cfa1c912c58a8064713b3e146d9e4841a21bca3f459b3e9204c3</cites><orcidid>0000-0003-3274-7128 ; 0000-0002-3490-090X ; 0000-0002-8401-4033</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.16345$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.16345$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38924288$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mills, Mark T.</creatorcontrib><creatorcontrib>Calvert, Peter</creatorcontrib><creatorcontrib>Lip, Gregory Y. H.</creatorcontrib><creatorcontrib>Luther, Vishal</creatorcontrib><creatorcontrib>Gupta, Dhiraj</creatorcontrib><title>Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking.
Methods
Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation).
Results
After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p < .001) and extended follow‐up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65–0.98; p = .032). This was driven by a lower rate of vascular complications during early follow‐up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52–0.83; p < .001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58–0.92; p = .007) and extended follow‐up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43–0.86; p = .005).
Conclusion
Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD.</description><subject>Ablation</subject><subject>Aged</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Bleeding</subject><subject>Blood transfusion</subject><subject>Cardiac arrhythmia</subject><subject>catheter ablation</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheterization, Peripheral - adverse effects</subject><subject>Catheters</subject><subject>Female</subject><subject>Femoral Vein</subject><subject>Femur</subject><subject>Fibrillation</subject><subject>Hemorrhage - etiology</subject><subject>Hemorrhage - prevention & control</subject><subject>Hemostasis</subject><subject>Hemostatic Techniques - adverse effects</subject><subject>Hemostatic Techniques - instrumentation</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Punctures</subject><subject>Radiofrequency ablation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>vascular closure device</subject><subject>Vascular Closure Devices</subject><subject>vascular injury</subject><issn>1045-3873</issn><issn>1540-8167</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kU1PxCAQhonR-LF68A8YEi96qEKBFo5m42dMvOi5oezUZUOLQrub_feydvVgIpeBmWfeDPMidErJFU3nemHgihaMix10SAUnmaRFuZvuhIuMyZIdoKMYF4RQVhCxjw6YVDnPpTxEw8vQG99CxL7BSx3N4HTAxvk4BMAzWFqTao0PuIHWB-3wEjo_RDxPz9jraDdV5_zKdu_Y6H4OPQSsa6d767uNqu6DTX2NrYN1Y_oY7TXaRTjZxgl6u7t9nT5kzy_3j9Ob58wwKkU2yyUDUwtGa8ZMo6lRNDdCakkKXlJWM6C8mCngklOd09po1nChUl7lhBs2QRej7kfwnwPEvmptNJCm6CB9omKkzEulcqESev4HXfghdGm6RMmSMCVFkajLkTLBxxigqT6CbXVYV5RUGy-q5EX17UViz7aKQ93C7Jf8WX4CrkdgZR2s_1eqnqa3o-QXE5GUTw</recordid><startdate>202408</startdate><enddate>202408</enddate><creator>Mills, Mark T.</creator><creator>Calvert, Peter</creator><creator>Lip, Gregory Y. H.</creator><creator>Luther, Vishal</creator><creator>Gupta, Dhiraj</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3274-7128</orcidid><orcidid>https://orcid.org/0000-0002-3490-090X</orcidid><orcidid>https://orcid.org/0000-0002-8401-4033</orcidid></search><sort><creationdate>202408</creationdate><title>Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation</title><author>Mills, Mark T. ; Calvert, Peter ; Lip, Gregory Y. H. ; Luther, Vishal ; Gupta, Dhiraj</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3185-d283ecb531b33cfa1c912c58a8064713b3e146d9e4841a21bca3f459b3e9204c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ablation</topic><topic>Aged</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Bleeding</topic><topic>Blood transfusion</topic><topic>Cardiac arrhythmia</topic><topic>catheter ablation</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheterization, Peripheral - adverse effects</topic><topic>Catheters</topic><topic>Female</topic><topic>Femoral Vein</topic><topic>Femur</topic><topic>Fibrillation</topic><topic>Hemorrhage - etiology</topic><topic>Hemorrhage - prevention & control</topic><topic>Hemostasis</topic><topic>Hemostatic Techniques - adverse effects</topic><topic>Hemostatic Techniques - instrumentation</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Punctures</topic><topic>Radiofrequency ablation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>vascular closure device</topic><topic>Vascular Closure Devices</topic><topic>vascular injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mills, Mark T.</creatorcontrib><creatorcontrib>Calvert, Peter</creatorcontrib><creatorcontrib>Lip, Gregory Y. H.</creatorcontrib><creatorcontrib>Luther, Vishal</creatorcontrib><creatorcontrib>Gupta, Dhiraj</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mills, Mark T.</au><au>Calvert, Peter</au><au>Lip, Gregory Y. H.</au><au>Luther, Vishal</au><au>Gupta, Dhiraj</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2024-08</date><risdate>2024</risdate><volume>35</volume><issue>8</issue><spage>1656</spage><epage>1662</epage><pages>1656-1662</pages><issn>1045-3873</issn><issn>1540-8167</issn><eissn>1540-8167</eissn><abstract>Introduction
Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking.
Methods
Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation).
Results
After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p < .001) and extended follow‐up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65–0.98; p = .032). This was driven by a lower rate of vascular complications during early follow‐up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52–0.83; p < .001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58–0.92; p = .007) and extended follow‐up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43–0.86; p = .005).
Conclusion
Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38924288</pmid><doi>10.1111/jce.16345</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-3274-7128</orcidid><orcidid>https://orcid.org/0000-0002-3490-090X</orcidid><orcidid>https://orcid.org/0000-0002-8401-4033</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Ablation Aged atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Bleeding Blood transfusion Cardiac arrhythmia catheter ablation Catheter Ablation - adverse effects Catheterization, Peripheral - adverse effects Catheters Female Femoral Vein Femur Fibrillation Hemorrhage - etiology Hemorrhage - prevention & control Hemostasis Hemostatic Techniques - adverse effects Hemostatic Techniques - instrumentation Humans Male Middle Aged Patients Punctures Radiofrequency ablation Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome vascular closure device Vascular Closure Devices vascular injury |
| title | Outcomes of vascular closure devices for femoral venous hemostasis following catheter ablation of atrial fibrillation |
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