Vascular Closure Devices Versus Standard Care in Patients Who Underwent Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis.
TL;DR
In patients with AF undergoing ablation, VCDs achieve homeostasis more rapidly than SC, with no significant difference observed between the two groups in terms of time to discharge, minor vascular complications, and same-day discharge.
Abstract
INTRODUCTION The adoption of vascular closure devices (VCDs) has gained prominence as an alternative to standard care (SC) for patients undergoing atrial fibrillation (AF) ablation. Although VCDs present potential benefits, there are ongoing concerns related to the duration required for hemostasis, the time until patient discharge, and the incidence of vascular complications. Therefore, we conducted a systematic review and meta-analysis to assess the outcomes associated with VCDs compared to SC.
Methods
We systematically searched the PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) and non-RCTs, comparing VCD with SC in patients who underwent AF ablation. Statistical analyses were performed using R 4.0.0. Heterogeneity was assessed using I2. We pooled the mean difference (MD) and odds ratio (OR) with 95% confidence intervals (CIs). Statistical significance was set at P < 0.05. The main continuous outcomes of interest included the time to hemostasis, the time until discharge, and the occurrence of minor vascular complications.
Results
A total of two RCTs and five cohort studies involving 30,560 patients were included. Of these, 15,343 (50%) received treatment with VCDs, and 15,217 (49.7%) received SC. The follow-up period varied from 1 wk to 3 mo. Patient ages varied from 58 to 66 y on average. VCDs had a shorter time to hemostasis than SC (MD = -5.63 min; 95% CI -7.30 to -3.95; P < 0.01; I2 = 99%). There was no difference in the two groups regarding time until discharge (MD = -10.68 h; 95% CI -21.98 to 0.63; P = 0.06; I2 = 100%). No statistical difference was found in the OR for minor vascular complications (OR 0.96, 95% CI 0.29-3.13; P = 0.941; I2 = 55%) and same-day discharge (OR 4.37, 95% CI 0.69-27.76; P = 0.118; I2 = 81%) between the two groups.
Conclusions
In patients with AF undergoing ablation, VCDs achieve homeostasis more rapidly than SC, with no significant difference observed between the two groups in terms of time to discharge, minor vascular complications, and same-day discharge.