Abstract 4363413: Safety and Effectiveness of Vascular Closure Devices in the Electrophysiology Laboratory: a Systematic Review and Meta-analysis

Abstract

Introduction: Manual compression and figure of eight sutures remain the standard practice (SP) for achieving hemostasis following venous access for electrophysiology (EP) procedures. However, vascular closure devices (VCDs) have emerged as alternatives designed to reduce time to hemostasis and ambulation without compromising patient safety. A conclusive comparison between VCDs and SP is lacking. This meta-analysis aims to evaluate the safety and effectiveness of VCDs compared with the SP in adult patients undergoing EP procedures. Methods: Medline, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and observational studies comparing VCDs to SP in EP procedures. SP consisted of manual compression alone or with the addition of figure of eight sutures. Continuous outcomes were pooled as mean differences (MD), and binary outcomes as risk ratios (RR), both with 95% confidence intervals (CI), using a random-effects model. Analyses were conducted in R version 4.3.2. Results: A total of 1,765 patients were included from nine studies, six of which were RCTs. VCDs were used in 916 (51.9%) patients. The majority of VCDs used were the Perclose ProGlide (66.6%). Follow-up ranged from 30 to 90 days. VCDs significantly reduced time to hemostasis (MD -7.03; 95% CI -8.77 to -5.28; p<0.01; Figure 1). Time to ambulation was also shorter in the VCD group (MD -2.70; 95% CI -3.65 to -1.75; p<0.0001). Although VCDs showed a nonsignificant trend toward reduced time to discharge (MD -5.44; 95% CI -22.28 to 11.39; p=0.38), they were associated with a significantly lower risk of access site hematomas (RR 0.22; 95% CI 0.07 to 0.70; p=0.01). Conclusions: In patients undergoing EP procedures, VCDs significantly reduced time to hemostasis, time to ambulation, and access site hematoma rates compared with manual compression and figure of eight sutures. These findings support the adoption of VCDs as a safe, time-efficient alternative to conventional hemostasis methods.