Key result
Modified figure-of-eight suture using a three-way stopcock achieved immediate hemostasis in 100% of patients compared to 90.7% with standard suture after cryoballoon ablation (P < .001).
Why the study?
Despite various precautions to achieve safe, effective, and complete femoral venous hemostasis after AF ablation, no standard approach exists.
Does a modified figure-of-eight suture using a three-way stopcock improve immediate venous hemostasis compared to standard suture in patients undergoing cryoballoon AF ablation?
RCT (n=150)
Sequential allocation
Does a modified figure-of-eight suture using a three-way stopcock improve immediate venous hemostasis compared to standard suture in patients undergoing cryoballoon AF ablation?
Absolute Event Rate: 100% vs 90.7%
p-value: p=<.001
A modified figure-of-eight suture using a three-way stopcock is a highly effective and safe alternative for achieving immediate hemostasis after 15 Fr femoral venous sheath removal in cryoballoon ablation.
mFoE shortens time to hemostasis vs sFoE after CB ablation; leaves open whether it improves safety or ambulation outcomes.
BACKGROUND: Immediate hemostasis following removal of sheaths is essential to prevent access site complications after atrial fibrillation (AF) ablation. Despite various precautions to achieve complete hemostasis in a safe and effective manner, no standard approach is present yet. OBJECTIVE: We aimed to compare the efficacy and safety of standard vs modified figure-of-eight (sFoE vs mFoE) suture for immediate venous hemostasis after cryoballoon (CB) AF ablation. METHODS: A total of 150 patients who underwent CB catheter ablation were sequentially allocated to either sFoE (n = 75) or mFoE (n = 75) suture to achieve immediate venous hemostasis at right femoral access site after 15 Fr sheath removal. A "three-way stopcock" was used in the mFoE group rather than tying the knot as in a sFoE group. Demographics, clinical and procedural data, and access site complications were recorded. RESULTS: Immediate haemostasis was achieved in all patients (n = 75) with mFoE suture as compared to 90.7% (n = 68) of sFoE suture group (P < .001). Light manual pressure of ≤1 min was required in five patients (6.7%) due to looseness and conventional manual compression because of the snapped silk suture during knotting was required in two patients (2.6%) in the sFoE group. Time to hemostasis was shorter in the mFoE group (P < .001), but time to ambulation and time to discharge were similar in both groups (P > .05). Although no minor or major access site complication has occurred in the mFoE group, in-hospital rebleeding (n = 2, 2.7%) and early local access site infection (n = 2, 2.7%) were observed in the sFoE group. CONCLUSION: The mFoE suture using three-way stopcock is an available, effective, maybe safe, and time- and cost-saving alternative technique to achieve immediate hemostasis after removal of 15 Fr right femoral venous sheath in patients undergoing cryoablation.
No takes yet. Share an insight, caveat, or question.
Yorgun et al. (2019) conducted an RCT in Atrial fibrillation (n=150). Modified figure-of-eight (mFoE) suture vs. Standard figure-of-eight (sFoE) suture was evaluated on Immediate hemostasis (p=<.001). Modified figure-of-eight suture using a three-way stopcock achieved immediate hemostasis in 100% of patients compared to 90.7% with standard suture after cryoballoon ablation (P < .001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: