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Incidence of vascular complications for electrophysiology procedures in the ultrasound era: a single-centre experience over 10,000 procedures in the long term

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Abstract

Background

Ultrasound (US) is being increasingly used to guide vascular access for electrophysiology (EP) procedures in many centres. Nonetheless, the incidence and predictors of vascular complications in the US era are limited. In this study, we describe our experience of vascular access-related complications associated with EP procedures which were performed with the routine use of US-guided vascular access.

Methods

A total of 10,158 consecutive EP procedures in 8361 patients performed from April 2014 (when our centre moved to a policy of routine US-guided vascular access for EP procedures) to March 2022 were included. The outcome of interest was any vascular access-related complication that occurred within 7 days of the procedure; these were classified as severe if surgical intervention and/or blood transfusion was required, major if non-surgical intervention or delayed hospital discharge was required, or minor if it did not fulfil the criteria for severe or major.

Results

During the study period, 2 (0.02%) severe vascular complications occurred, including 1 pseudo-aneurysm requiring surgery and 1 retroperitoneal haemorrhage requiring blood transfusion. Nine (0.09%) major complications occurred, including 6 hematomas managed by compression devices, 1 type B aortic dissection, 1 AV fistula managed conservatively and 1 haematoma managed conservatively but delayed hospital discharge. Eighteen (0.18%) minor haematomas were seen that did not require any intervention or delayed hospital discharge. On multivariable analysis, female sex [OR (95% CI): 2.5 (1.2, 5.4)] and use of an arterial access [OR (95% CI): 19.3 (7.1, 52.3)] were seen to be independent predictors of the 29 vascular complications.

Conclusion

With the use of US-guided vascular access in EP procedures, major vascular complications are exceedingly rare, particularly those needing surgical intervention. Our results provide additional evidence for scientific guidelines to support US use.

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Authors and Affiliations

  1. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK

    Wern Yew Ding & Dhiraj Gupta

  2. Liverpool Heart and Chest Hospital, Liverpool, UK

    Dibbendhu Khanra, Nikola Kozhuharov, Matthew Shaw, Vishal Luther, Reza Ashrafi, Zoltan Borbas, Saagar Mahida, Simon Modi, Mark Hall, Richard Snowdon, Johan Waktare & Derick Todd

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  1. Wern Yew Ding
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Correspondence to Dhiraj Gupta.

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Ethics approval

The study was approved by the institutional ethics committee.

Informed consent

Written informed consent was obtained from each patient.

Conflict of interest

DG: Speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic, Biosense Webster and Boston Scientific. Proctor for Abbott. Research Grants from Medtronic, Biosense Webster and Boston Scientific. All other authors declare no competing interests.

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Wern Yew Ding and Dibbendhu Khanra are joint first co-authors.

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Ding, W.Y., Khanra, D., Kozhuharov, N. et al. Incidence of vascular complications for electrophysiology procedures in the ultrasound era: a single-centre experience over 10,000 procedures in the long term. J Interv Card Electrophysiol 66, 693–700 (2023). https://doi.org/10.1007/s10840-022-01386-8

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