Abstract

Background: Vascular recovery from catheter ablation (CA) generally requires a period of leg immobilization. Vascular closure devices reduce the length of bedrest and promote earlier discharge, however, a period of immobilization is still routinely observed. The objective of this study was to compare a strategy of immediate leg mobilization (IM) using percutaneous suture-mediated closure devices against figure-of-eight sutures and 4h bed rest (BR) after CA of atrial fibrillation (AF) using large vascular access sheaths for cryoballoon (CBA) and pulsed-field ablation (PFA). Methods: A total of 98 subjects were analyzed (49 IM and 49 BR). Vascular closure in IM consisted of a single percutaneous suture-mediated closure device (Perclose ProStyle) delivered to each of 3 venous access sites in a single groin. Following the procedure, both legs could be mobilized immediately with no head-of-bed restriction. Ambulation was instructed at 1h post-procedure, and discharge was scheduled at 3h. Hemostasis in BR was achieved using figure-of-eight sutures delivered to one or both groins utilized for access, and 4h bedrest. In both groups, one of the sheaths consisted of a 12F to 17F access for CBA or PFA. Protamine was administered prior to the removal of sheaths. Oral anticoagulation was resumed same day. The primary endpoint was the incidence of vascular complications. The secondary endpoint was time to discharge. Results: Baseline characteristics between groups were similar (Age 67.8 ± 13.1 years, BMI 30.2 ± 6.8, LVEF 55.7 ± 12.4, 48% female). 55% of IM and 100% of BR underwent CBA. The remainder underwent PFA. There was no difference in the rate of vascular complications between the two groups (1 IM vs 0 BR, p = 0.315 ). The time to discharge was significantly shorter in the IM group (3.9 ± 0.8 vs 5.4 ± 1.0 h, p < 0.0001 ). Conclusions: In this single-center study, immediate mobilization facilitated by suture-mediated vascular closure following catheter ablation using large access sheaths was associated with no difference in vascular complications compared to bedrest and resulted in earlier discharge. Larger studies evaluating cost, clinical endpoints, and patient-reported outcomes are needed.