Abstract 15833: Imaging-Assisted versus Conventional Blind Technique for Venous Access in Patients Undergoing Catheter Ablation of AF Under Therapeutic Warfarin: Differences Between Femoral and Internal Jugular Vein Accesses
Introduction. Periprocedural maintenance of therapeutic warfarin is an increasingly implemented anticoagulation protocol in patients undergoing catheter ablation of atrial fibrillation (AF). Obtaining venous accesses is a key step of the procedure, with a small but definite risk of vascular complications. We compared imaging-assisted versus conventional blind technique for obtaining venous accesses in patients undergoing AF ablation under therapeutic warfarin.
Methods. Data on vascular complications related to venous access were prospectively collected in a registry including 7188 patients undergoing AF ablation without interruption of therapeutic warfarin. Three femoral venous (FV) accesses (2 on the right and 1 on the left) and 1 right internal jugular (IJ) vein access were obtained in all patients. Conventional landmark-assisted blind access or either ultrasound-guided (FV and/or IJ accesses) or fluoroscopy-guided puncture after advancing a catheter from the groin (only for IJ access), were used at the discretion of the operator.
Results. Imaging-assisted puncture was performed in 1079 (15%) cases for FV access, and in 7075 (98%) cases for IJ access. In the remaining patients, blind access was obtained using conventional anatomical landmarks. Overall, vascular complications occurred in 287 (4%) cases (9 major complications), of which 266 (93%) were related to the FV accesses, and 21 (0.29%) to the IJ access. Imaging-assisted access had no significant impact on the rate of complications related to the FV access (231 [3.8%] in the conventional access vs. 35 [3.2%] in the ultrasound-guided access group, P = 0.44), while, for IJ access, it strikingly reduced the rate of both total (12% in the conventional access vs. 0.1% in the fluoroscopy-assisted access group, P < 0.001) and major complications (5% vs. 0%, P < 0.001). Owing to such results, blind internal jugular vein access was abandoned after the first 113 cases.
Conclusions. In patients undergoing catheter ablation of AF under therapeutic warfarin, imaging-assisted venous access strikingly reduces the risk of total and major vascular complications related to the internal jugular vein access, while it does not impact the risk of femoral vein access complications.
- © 2012 by American Heart Association, Inc.