Vascular Access and Closure Management for Electrophysiological Interventions: Small Interventions Big Impact.

Purpose of the review: This review examines the role of vascular access and closure management in cardiac electrophysiology (EP) procedures, emphasising their impact on patient outcomes and safety. It synthesises current evidence and highlights advancements, challenges, and opportunities in this critical area of EP practice.

Recent findings: Ultrasound-guided vascular access has significantly reduced complications and improved success rates compared to traditional methods. Vascular closure devices (VCDs) enable faster recovery and same-day discharge, becoming superior alternatives to manual compression. The "4P framework"- Plan, Prepare, Puncture, Protect- offers a structured approach to optimising vascular access. Alternative techniques, such as transhepatic and jugular access, are feasible in complex cases, though large-scale evidence is limited. Vascular access management is essential for EP procedures, demanding adequate planning and execution. While advancements in imaging and closure techniques enhance outcomes, further research is needed to standardise practices and evaluate long-term results. A personalised, systematic approach ensures optimal procedural success and patient care.