title: Venous hemostasis postcatheter ablation of atrial fibrillation while under therapeutic levels of oral and intravenous anticoagulation.
abstract: OBJECTIVE
  Catheter ablation of atrial fibrillation (AF) requires utilizing multiple venous femoral sheaths in conjunction with aggressive periprocedural anticoagulation, which can lead to increased risk of vascular access complications. The objective of this study is to evaluate the safety and efficacy of the "figure-of-eight" ("F-8") suture technique for femoral venous hemostasis while on therapeutic doses of intravenous anticoagulation at the time of sheath removal.
  
  
  METHODS
  In this case-control analysis, 376 consecutive patients underwent AF ablation while on uninterrupted oral anticoagulation and received intraprocedural heparin. In the first 253 patients (the control group), manual pressure was used for femoral venous hemostasis after reversal of heparin effects. The subsequent 123 patients (the F-8 group) had femoral venous hemostasis using the F-8 suture technique and while under therapeutic heparin effects.
  
  
  RESULTS
  The F-8 subcutaneous suture technique achieved adequate venous hemostasis in 98.4% of patients. As compared to the control group, there was significantly less frequent utilization of the FemoStop compression assist device (1.2 vs. 16.8%, p < 0.0001) and in a significantly shorter interval (6.8 ± 5.7 vs. 50.7 ± 12.2 min, p < 0.0001). Vascular access complications and thromboembolic events occurred in 9.8% in the F-8 group vs. 13.0% in the control group (p = 0.678).
  
  
  CONCLUSIONS
  Immediate hemostasis of the femoral venous access sites after insertion of multiple sheaths for AF ablation in the presence of anticoagulation can be safely and effectively achieved using the F-8 suture technique. This technique helps minimize the period of inadequate anticoagulation immediately following ablation and shortens the time required to achieve adequate hemostasis.
authors.affiliation: Prairie Heart Institute, Prairie Cardiovascular Consultants, 619 East Mason Street, Springfield, IL, 62701, USA. zissa@prairieheart.com.|Southern Illinois University, Carbondale, IL, USA. zissa@prairieheart.com.
authors.forename: Ziad F
authors.initials: ZF
authors.lastname: Issa
authors.affiliation: Southern Illinois University, Carbondale, IL, USA.
authors.forename: Bashar S
authors.initials: BS
authors.lastname: Amr
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000706:statistics & numerical data; D005260:Female; D005268:Femoral Vein / Q000601:surgery; D006489:Hemostatic Techniques / Q000295:instrumentation / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques / Q000295:instrumentation* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Ablation; Anticoagulation; Atrial fibrillation; Vascular hemostasis