Comparative effectiveness of figure-of-eight suture and manual compression for femoral venous hemostasis after atrial fibrillation ablation: A grade assessed meta-analysis

Atrial fibrillation is a common cardiac arrhythmia associated with serious complications such as stroke, heart failure, and mortality. Catheter ablation is frequently used for drug-resistant cases but requires femoral venous access and anticoagulation, increasing the risk of vascular complications. Manual compression is the standard method for post-ablation hemostasis, though it can be time-consuming and uncomfortable, whereas figure-of-eight sutures have emerged as a potential alternative. To compare safety and procedural outcomes of figure-of-eight sutures versus manual compression for venous hemostasis after ablation. A systematic literature search was conducted across Cochrane Library, PubMed/MEDLINE, Scopus, and Embase up to February 2026 to identify studies comparing figure-of-eight (Fo8) sutures with manual compression for post-ablation femoral venous hemostasis. Randomized controlled trials and observational cohort studies were included. Data extraction and quality assessment were performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analyses and meta-analyses were performed using RevMan software version 5.4. Nine studies with a total of 2,125 patients were analyzed. Figure-of-Eight (Fo8) suturing demonstrated no significant difference compared with manual compression for total, major, or minor vascular access site complications, bleeding, or hematoma. However, FO8 suturing was associated with significantly shorter time to hemostasis, earlier ambulation, and reduced time to discharge. Figure-of-eight suturing is as safe as manual compression for post-ablation femoral venous hemostasis, showing no increase in vascular access-site complications, bleeding, or hematoma. It provides the added benefit of faster hemostasis, earlier ambulation, and reduced discharge time.