Po-01-021 vascular access complications during catheter ablation of ventricular arrhythmias: impact of vascular closure device

In patients (pts) with ventricular arrhythmias (VAs) undergoing catheter ablation (CA), the need for multiple vascular access points with large bore sheaths predisposes to vascular complications. Whether arterial/venous vascular closure devices prevent vascular complications is unknown. We investigated the benefit of vascular closure devices in pts undergoing CA of VAs. Consecutive pts undergoing CA of VAs between 2018-2020 were included. Vascular accesses were obtained with ultrasound guidance. At the discretion of the operator, arterial (Perclose or AngioSeal) and/or venous (Vascade or figure-of-eight suture) were used. Pts were divided into 3 groups: no use of vascular closure devices for any of the arterial/venous accesses (No-Closure), use of vascular closure devices for some but not the all of the arterial/venous accesses (Partial-Closure), use of vascular closure devices for all of the arterial/venous accesses (Complete-Closure). Vascular complications were defined minor if they didn’t require intervention or major if they required intervention (transfusion, percutaneous/surgical repair). 522 pts (62±13 years, BMI 30±6 kg/m2, 26% female) underwent ablation of VT (41%) or PVCs (59%) during the study period. 134 (34%) were on oral anticoagulation before the procedure (interrupted in 129, uninterrupted in 5). 477 arterial accesses were obtained in 471 (90%) pts (single access in 465 pts – 7.5±1.4 Fr size, two accesses in 6 – 7±1.5 Fr and 7±4 Fr). 1258 venous accesses were obtained in 520 (99.6%) pts (unilateral in 24%, bilateral in 75.6%, N. of accesses 2.4±0.7/pt, size 8.4±1.33 Fr). 142 (27%) pts received No-Closure, 201 (39%) Partial-Closure and 179 (34%) Complete-Closure. A vascular access-related complication occurred in 31 (5.9%) pts, including a minor hematoma in 4.6% and a major complication in 1.3%. The rate of vascular complications was 7% (5.6% minor and 1.4% major) in the No-Closure group, 6.9% (5% minor and 1.9% major) in the Partial-Closure group, and 3.9% (3.4% minor and 0.5% major, P=0.15 for comparison) in the Complete-Closure group. In pts undergoing CA of VAs, Complete-Closure using dedicated arterial/venous closure devices/sutures appeared associated with lower absolute rates of minor and major vascular-related complications compared to No-Closure or Partial-Closure. Although the differences did not reach statistical significance, they suggest a potential benefit of Complete-Closure and require further investigation in larger cohorts.