A call for safety during electrophysiological procedures: US in, why not US out?

We read with great interest the paper by Sobolevet al.1 entitled ‘Ultrasound-guided cannulation of the femoral vein in electrophysiological procedures: a systematic review and meta-analysis’. Like all meta-analyses, it does not provide certainties but may set the stage for launching randomized trials on this important topic. Vascular damages during electrophy siological (EP) procedures are critical events which may have a substantial impact on patients prognosis, thus increasing their anxiety and fear towards the procedure. Furthermore, when compared with other complications (i.e. atrioventricular block, embolic events, cardiac tamponade), the vascular o nes seem to be relatively frequent, being recently reported in similar or even higher percentages in recent studies. These data are not surprising if we consider that over the last few years, patients on anticoagulant therapy have become a very represented population in the setting of EP procedures. Moreover, many of these procedures are complex and require the introduction of several wide sheaths often in the same vein, or—alternatively—a retrograde approach through the femoral artery when the ipsilateral vein is already cannulated.2 However, the major determinant of vascular complications is still represented by vein cannulation. Since femoral vein cannulation has been performed palpation of external anatomical landmarks has been usually employed to guide the insertion of the needle into the vessel. However, this pr...
Source: Europace - Category: Cardiology Source Type: research
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