Reduced Vascular Complications After Catheter Ablation Applying Sonography‐Guidance and Modified Postprocedural Care

Background Vascular access and postprocedural access site management remain the leading causes for postprocedural complications following interventional electrophysiological (EP) procedures. Method Patients were consecutively included in a prospective registry (TRUST, NCT05521451). Two vascular access and groin‐site management protocols that changed as an institutional standard at a cut‐off date (August 15, 2022) were compared. Group I used conventional access with an 8‐h pressure bandage and bed rest. Group II utilized ultrasound‐guided access, figure‐of‐8 suture, a 2‐h pressure bandage, and 6 h total bed rest. Minor complications included hematoma, bleeding, AV fistula, or pseudoaneurysm not requiring intervention. Major complications involved any incident necessitating intervention (transfusion, surgery, interventional therapy) or retroperitoneal hematoma. Results A total of 1672 procedures in 1501 patients (median age 65 (IQR 56.74) years, 38% female) were analyzed. Clinical features were balanced with the exception of a higher body mass index (median 27 [24;31] vs. 26 [24;30], p = 0.011) and more frequent arterial hypertension (63% vs. 56%, p = 0.003) in Group I. Total vascular complication rate was 9% (69/780 procedures) for Group I, and 4% (40/892 procedures) for Group II (OR 0.48 [95% CI: 0.32–0.73], p < 0.001). Major complications occurred in 30/109 (28%) cases, of which 20/780 (3%) occurred in Group I and 10/892 (1%) in Group II (OR 0.43 [95% CI: 0.18–0.97], p = 0.042). Hematomata were most frequently observed in both groups (Group I: 46/69, 67%; Group II: 30/40, 75%). Conclusion Vascular complication rates in EP‐procedures were significantly reduced by implementing a novel institutional groin‐site management standard including ultrasound‐guided vascular access and modified post‐interventional care.