Immediate Leg Mobilization is Feasible After Catheter Ablation of Atrial Fibrillation Using Large Vascular Access Sheaths (Pulsed Field and Cryoballoon Ablation).

Abstract

Background: Vascular recovery from catheter ablation (CA) has traditionally required a period of leg immobilization which can lead to discomfort and prolonged time to discharge.

Objective: The objective of this study was to compare a strategy of immediate leg mobilization (IM) using suture-mediated closure devices against traditional vascular recovery consisting of figure-of-eight suture and 4 h bed rest (BR) after CA of atrial fibrillation (AF) using large vascular access sheaths for cryoballoon ablation (CBA) and pulsed field ablation (PFA).

Methods: Two hundred subjects were retrospectively analyzed: 100 IM and 100 BR. Vascular closure in IM consisted of a single suture-mediated closure delivered to each of three venotomies. Following the procedure, both legs could be mobilized immediately with no head-of-bed restriction. Ambulation was instructed at 1 h, and discharge at 3 h postprocedure. Hemostasis in BR was achieved using figure-of-eight sutures and 4 h of BR. The primary endpoint was the incidence of vascular complications. The secondary endpoint was time to discharge.

Results: The mean age was 68.4 ± 11.7 years. In total, 72% of subjects in IM and 5% of the subjects in BR were treated with PFA. There was no difference in vascular complications (1 IM vs. 0 BR, p = 0.316). Time to discharge was shorter in IM (4.2 ± 2.6 h vs. 6.0 ± 2.7 h, p < 0.05).

Conclusion: Immediate mobilization with suture-mediated vascular closure following CBA or PFA was associated with no difference in vascular complications compared to 4 h BR and shorter time to discharge. Further studies are needed to illustrate potential benefits to patient comfort and satisfaction.