Suture‐based techniques versus manual compression for femoral venous haemostasis after electrophysiology procedures

Abstract Background and aims Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture‐based techniques such as a figure‐of‐eight suture secured with a hand‐tied knot (Fo8 HT ) or a modified figure‐of‐eight suture secured with a 3‐way stopcock (Fo8 MOD ). We hypothesised that short‐term bleeding outcomes using the Fo8 MOD approach would be superior to MC. We additionally compared outcomes between Fo8 MOD and Fo8 HT approaches. Methods We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8 HT and Fo8 MOD . Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression). Results 1089 patients were included: MC 718 (65.9%); Fo8 HT 105 (9.6%); Fo8 MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re‐entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8 MOD associated with fewer complications than MC or Fo8 HT (major: MC 2.2%, Fo8 HT 6.0%, Fo8 MOD 0.8%, p = .01; minor: MC 16.5%, Fo8 HT 12.0%, Fo8 MOD 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8 MOD was associated with a significantly lower risk of access site complications (OR 0.29 95% CI 0.17–0.48, p < .001), whilst intraprocedural heparinisation (OR 5.25 2.88–9.69, p < .001) and larger maximal sheath size (OR 1.06 1.00–1.11, p = .04) were associated with a higher risk of complications. Conclusion Femoral haemostasis with Fo8 MOD associates with fewer access site complications than MC and Fo8 HT following EP procedures that need periprocedural anticoagulation.