N. Farid1, C.E. Batista De Lima2 1Mohiuddin Islamic Medical college, Mirpur, AZAD KASHMIR (AJK), Pakistan 2Federal university of piaui, Teresina, PIAUÍ, Brazil
Introduction: The use of vascular closure devices (VCDs) has become increasingly prevalent as an alternative to Standard care (SC) in patients underwent to ablation therapy for AF. While VCDs offer potential advantages, there are some concerns regarding extent of time to hemostasis, quicker discharge and vascular complications. This meta-analysis aims to systematically compare the outcomes associated with VCDs versus standard care (manual compression and figure of 8 suture).
Methods: We systematically searched PubMed, Embase, Cochrane databases for randomized (RCTs) and non-randomized controlled trials comparing VCD with SC in patients who underwent afib ablation . Statistical analysis was performed using R 4.0.0. Heterogeneity was assessed using I² . We pooled MD and OR with 95% confidence intervals (CI). P values of < 0.05 were considered statistically significant.The primary continuous outcomes of interest were time to hemostasis (TTH), time up to discharge (TTD) and minor vascular complications.
Results:Two RCTs and five cohort studies reporting data on 30,560 patients were included. Among them 15,343 treated with VCDs and 15,217 were having standard care.The follow up time was from 1 week to three months. The mean age of patients between studies ranged from 58 to 66 years. VCDs have a shorter TTH as compared to SC (MD -5.63min ; 95% CI -7.30 to -3.95 ; p < 0.01; I² = 99%). There was no difference in both groups regarding TTD (MD -10.68h ; 95% CI -21.98 to 0.63; p =0.06; I²=100% ) .There was no statistical difference in OR for minor vascular complications (OR 0.96; 95% CI 0.29 to 3.13; p=0.941; I²=55%) and same day discharge (OR 4.37; 95% CI 0.69 to 27.76; p= 0.118; I²=81%) between both groups.
Conclusion:Our findings indicate that in patients with AF who undergo ablation, VCDs achieve hemostasis more quickly compared to SC, while there is no significant difference between the two groups in terms of time to discharge, minor vascular complications, and same-day discharge.