Péter Kupó1,2, Róbert Pap3, László Sághy3, Dalma Tényi4, Alexandra Bálint5, Dorottya Debreceni5, Indranill Basu-Ray6,7, András Komócsi5. 1. Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary. peter.kupo@gmail.com. 2. Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary. peter.kupo@gmail.com. 3. Second Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Szeged, Hungary. 4. Department of Neurology, Medical School, University of Pécs, Pécs, Hungary. 5. Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, Pécs, H-7624, Hungary. 6. St. Francis Hospital, Memphis, TN, USA. 7. All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh, Uttarakhand, India.
Abstract
PURPOSE: The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. METHODS: Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). RESULTS: Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = - 92.1 s, 95% CI, - 142.12 - - 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). CONCLUSION: Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.
PURPOSE: The most common complications of electrophysiology (EP) procedures are related to vascular access. Our study aims to conduct a meta-analysis comparing ultrasound (US)-guided vs. palpation-based technique for femoral venous access in EP procedures. METHODS: Electronic databases were searched and systematically reviewed for studies comparing femoral vein puncture with/without US in EP procedures. The primary outcome was the rate of major vascular complications; secondary outcomes were minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time. Predefined subgroup analysis was conducted separately for patients undergoing pulmonary vein isolation procedure (PVI). A random-effects model was used to derive risk ratios (RR) with 95% confidence interval (CI). RESULTS: Nine studies involving 8232 patients met our inclusion criteria. Compared with the standard technique, the use of US reduced major vascular complications (from 2.01 to 0.71%, p < 0.0001). The rate of minor vascular complications (RR = 0.30, 95% CI, 0.14-0.62, p = 0.001) and inadvertent artery puncture were lower with US-guided puncture (RR = 0.31, 95% CI, 0.17-0.58, p = 0.0003). Puncture time was shorter (mean difference = - 92.1 s, 95% CI, - 142.12 - - 42.07 s, p = 0.0003) and postprocedural groin pain was less frequent (RR = 0.57, 95% CI, 0.41-0.79, p = 0.0008) in the US group. Subgroup analysis of patients undergoing PVI also showed significant reduction of major vascular complications (RR = 0.27, 95% CI, 0.12-0.64, p = 0.003) and inadvertent artery puncture (RR = 0.35, 95% CI, 0.21-0.59, p < 0.0001). CONCLUSION: Real-time US-guidance of femoral vein puncture in EP procedures is beneficial: it reduces major and minor vascular complications, inadvertent artery puncture, postprocedural groin pain, and puncture time.
Authors: David Duncker; Philipp Sommer; Sonia Busch; Roland R Tilz; Till Althoff; Leon Iden; Andreas Metzner; Andreas Rillig; K R Julian Chun; Felix Bourier; Tilman Maurer; Dong-In Shin Journal: Herzschrittmacherther Elektrophysiol Date: 2021-05-19
Authors: Indranill Basu-Ray; Dibbendhu Khanra; Péter Kupó; Jared Bunch; Sue A Theus; Anindya Mukherjee; Sumit K Shah; András Komócsi; Adedayo Adeboye; John Jefferies Journal: J Arrhythm Date: 2021-01-29