BACKGROUND: Data on ultrasound-guided vascular access (UGVA) to reduce vascular access complications in adult congenital heart disease (ACHD) patients undergoing catheter ablation (CA) on uninterrupted oral anticoagulation (OAC) are limited. OBJECTIVE: Comparison of UGVA to a standard approach with regard to vascular access complications in ACHD patients. METHODS: We retrospectively analyzed 477 consecutive ACHD patients (52% male, mean age 46 ± 14 years) with simple (n = 166), moderate (n = 133), and complex (n = 178) congenital heart disease (CHD) who underwent 639 CA procedures for atrial tachycardia or fibrillation between 2014 and 2024. UGVA (243 patients, 271 ablations) was compared to a conventional approach (234 patients, 368 ablations) regarding vascular access complications under uninterrupted OAC (DOAC or VKA). RESULTS: Access was obtained via the femoral vein (n = 321), both femoral vein and artery (n = 311), or jugular vein with femoral artery (n = 7). UGVA significantly reduced overall vascular access complications compared to the standard approach (4.1% vs. 13.5%; p 5 cm, small AV fistulas treated conservatively, or pseudoaneurysms treated by compression or ultrasound-guided thrombin injection-were also significantly lower with UGVA (4.1% vs. 12.5%; p < 0.001). CONCLUSIONS: UGVA significantly decreases vascular access complications in ACHD patients undergoing CA on uninterrupted OAC and may be advantageous for routine use in clinical practice.
Telishevska et al. (2026) studied this question.