Vascular closure devices reduce access-site complications and improve procedural efficiency in adult electrophysiology: a systematic review and meta-analysis of 40,632 patients

Background/Introduction Femoral vascular access is integral to electrophysiology (EP) procedures but is associated with bleeding risks and delayed ambulation. While Manual Compression (MC) remains the standard, Vascular Closure Devices (VCDs) have been introduced to expedite recovery. Existing evidence regarding VCDs in the specific setting of adult EP remains conflicting. Purpose This project was undertaken to systematically evaluate the safety and operational efficiency of VCDs versus manual compression in adult EP procedures, given the lack of consensus in current guidelines. We hypothesized that VCDs would significantly reduce time-to-hemostasis and ambulation without increasing the risk of vascular complications or infection. Methods A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines by searching PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus from inception through January 2026. The analysis included Randomized Controlled Trials (RCTs) and observational studies involving adults (≥18 years) undergoing diagnostic EP or catheter ablation; structural interventions were excluded. Data were managed using a random-effects meta-analysis. Safety outcomes were calculated as Risk Ratios (RRs) and efficiency outcomes as Standardized Mean Differences (SMDs) with 95% Confidence Intervals (CIs).Subgroup analysis was also done to compare the outcomes across both trial setting as well as real world evidence. Results Eighteen studies (10 randomized controlled trials and 8 observational studies) involving 40,632 patients were included. Compared with manual compression, VCD was associated with significantly lower risks of access-site hematoma (RR, 0.59; 95% CI, 0.46–0.71), major bleeding (RR, 0.72; 95% CI, 0.55–0.88), minor bleeding (RR, 0.55; 95% CI, 0.17–0.93), and pseudoaneurysm formation (RR, 0.69; 95% CI, 0.54–0.83), with minimal heterogeneity for these outcomes. Absolute risk reductions were modest (number needed to treat: 90 for hematoma; 430 for pseudoaneurysm). VCDs significantly reduced time to hemostasis (SMD, −2.90; 95% CI, −3.71 to −2.08), time to ambulation (SMD, −1.84; 95% CI, −2.45 to −1.24), and time to hospital discharge (SMD, −1.12; 95% CI, −1.66 to −0.58), although heterogeneity for time-based outcomes was high. No significant differences were observed in infection or hospital readmission rates. Conclusion In adult electrophysiology procedures, vascular closure devices are associated with modest absolute reductions in access-site complications and substantial improvements in procedural efficiency, without increasing the risk of infection. These findings support the adoption of VCDs to optimize patient recovery and workflow, particularly in high-volume EP centersVisual Abstract