# Incidence, Predictors, and Management of Femoral Vascular Complications Following Catheter Ablation for Atrial Fibrillation: A Systematic Duplex Ultrasound Study

## TL;DR

This study found that 6.4% of patients had femoral vascular complications after catheter ablation for atrial fibrillation, with repeat procedures and less operator experience being key risk factors.

## Contribution

The study introduces systematic duplex ultrasound for detecting vascular complications and identifies new predictors like repeat ablation and operator experience.

## Key findings

- Vascular complications occurred in 6.4% of patients, higher than previously reported.
- Repeat ablation and less than six months of operator experience were significant predictors.
- DUS-guided compression effectively managed most complications, but AVFs required more intervention.

## Abstract

Background/Objectives: Catheter ablation is an effective treatment for atrial fibrillation (AF) but is associated with femoral vascular complications. While anticoagulation therapy has been linked to these complications, specific risk factors remain unclear. This study assessed the incidence and predictors of vascular complications after catheter ablation using systematic duplex ultrasound (DUS) as well as their outcomes. Methods: A single-center observational study was conducted with 404 consecutive AF patients who underwent catheter ablation between March 2023 and February 2024. DUS was performed systematically post-procedure in all patients to identify complications; these were primarily treated with DUS-guided manual compression. Results: Vascular complications were observed in 6.4% of patients, higher than reported in previous studies. Hematomas (3.5%) and arteriovenous fistulas (AVFs, 2.0%) were the most common such complications. Multivariate analysis identified repeat ablation (odds ratio [OR] 3.09, 95% confidence interval [CI] 1.10–8.64, p = 0.03) and months of experience <6 months (OR 3.42, 95% CI 1.36–8.63, p = 0.01) as significant predictors of complications. DUS-guided compression managed most complications successfully, with three pseudoaneurysms resolved through compression and one through embolization. However, AVFs were relatively resistant to conservative management, often necessitating prolonged observation or intervention. Conclusions: Systematic DUS following catheter ablation revealed a higher-than-expected incidence of vascular complications. Repeat ablation and months of experience <6 months are potential predictors of femoral vascular complications. DUS-guided compression is effective for most complications, although AVFs present greater treatment challenges.