title: Improving safety in catheter ablation for atrial fibrillation: a prospective study of the use of ultrasound to guide vascular access.
abstract: BACKGROUND
  The most frequent complications of AF ablation (AFA) are related to vascular access, but there is little evidence as to how these can be minimized.
  
  
  METHODS
  Consecutive patients undergoing AFA at a high-volume center received either standard care (Group S) or routine ultrasound-guided vascular access (Group U). Vascular complications were assessed before hospital discharge and by means of postal questionnaire 1 month later. Outcome measures were BARC 2+ bleeding complications, postprocedural pain, and prolonged bruising.
  
  
  RESULTS
  Patients in Group S (n = 146) and U (n = 163) were well matched at baseline. Follow-up questionnaires were received from 92.6%. Patients in Group U were significantly less likely to have a BARC 2+ bleed, 10.4% versus 19.9% P = 0.02, were less likely to suffer groin pain after discharge (27.1% vs. 42.8%; P = 0.006) and were less likely to experience prolonged local bruising (21.5% vs. 40.4%; P = 0.001). Multivariable logistic regression analysis revealed a significant association of vascular complications with nonultrasound guided access (OR 3.12 95%CI 1.54-5.34; P = 0.003) and increasing age (OR 1.05 95%CI 1.01-1.09; P = 0.02).
  
  
  CONCLUSIONS
  Routine use of ultrasound-guided vascular access for AFA is associated with a significant reduction in bleeding complications, postprocedural pain, and prolonged bruising when compared to standard care.
authors.affiliation: The Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Imperial College London, London, United Kingdom.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Wynn
authors.forename: Iram
authors.initials: I
authors.lastname: Haq
authors.forename: John
authors.initials: J
authors.lastname: Hung
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bonnett
authors.forename: Gavin
authors.initials: G
authors.lastname: Lewis
authors.forename: Matthew
authors.initials: M
authors.lastname: Webber
authors.forename: Johan E P
authors.initials: JE
authors.lastname: Waktare
authors.forename: Simon
authors.initials: S
authors.lastname: Modi
authors.forename: Richard L
authors.initials: RL
authors.lastname: Snowdon
authors.forename: Mark C S
authors.initials: MC
authors.lastname: Hall
authors.forename: Derick M
authors.initials: DM
authors.lastname: Todd
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003288:Contusions / Q000209:etiology / Q000517:prevention & control; D004739:England; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: atrial fibrillation; catheter ablation; complications; ultrasound; vascular complications