EP Quiz

Test Your Knowledge: Femoral Ultrasound Access

Quiz provided by Jonathan Salcedo, MD, FACC, FHRS. 

Quiz provided by Jonathan Salcedo, MD, FACC, FHRS. 

1. The most common complication resulting from ablation for atrial fibrillation is:

A.  Pericardial tamponade

B.  Atrio-esophageal fistula

C.  Vascular complication

D.  Stroke

2. Uninterrupted dabigatran etexilate versus uninterrupted warfarin does not make a difference in major bleeding events during atrial fibrillation ablation.

A. True

B. False

3. As opposed to arterial, more inferior femoral venous access is safer and preferred to superior venous access due to risk of retroperitoneal bleed.

A.  True

B.  False

4. For atrial fibrillation ablations, ultrasound venous access has been associated with:

A.  Lower bleeding rates

B.  Less pain

C.  Less bruising

D.  Both A and C

E.  All of the above

F.  None of the above

5. Ultrasound venous access for ventricular tachycardia, atrial fibrillation, and other catheter-based procedures has been associated with:

A.  Longer procedural times

B.  Lower incidence of vascular complications

C.  Lower incidence of major complications

D.  Both B and C

E.  All of the above

F.  None of the above

For more information on this topic, please see this article by Dr. Salcedo in our May 2020 issue of EP Lab Digest: https://bit.ly/2Nxfwm1

 

Answers

1. (C) Vascular complication: Minor and major vascular complications are the most common complication related to atrial fibrillation ablation. Reference: Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444.

2. (B) False: Uninterrupted dabigatran was associated with significantly lower bleeding events during and up to 8 weeks post-ablation compared with uninterrupted warfarin. Reference: Calkins H, Gerstenfeld EP, Schilling R, Verma A, Willems S; RE-CIRCUIT Study Steering Committee. RE-CIRCUIT study-randomized evaluation of dabigatran etexilate compared to warfarin in pulmonary vein ablation: assessment of an uninterrupted periprocedural anticoagulation strategy. Am J Cardiol. 2015;115(1):154-155.

3. (B) False: When an inferior approach to femoral vein access is used, small medial branches of the femoral artery, which can run across and superficial to the femoral vein, might be penetrated before entry to the femoral vein, possibly leading to a femoral pseudoaneurysm and arteriovenous fistula. Reference: Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444.

4. (E) All of the above: Using ultrasound-guided vascular access for atrial fibrillation ablation procedures is associated with significantly less bleeding complications, postprocedural pain, and prolonged bruising compared with standard care. Reference: Wynn GJ, Haq I, Hung J, et al. Improving safety in catheter ablation for atrial fibrillation: a prospective study of the use of ultrasound to guide vascular access. J Cardiovasc Electrophysiol. 2014;25(7):680-685.

5. (D) Both B and C: For VT ablations, AF ablations, and other catheter-based procedures, ultrasound-guided access is associated with lower total and major complications compared with non-ultrasound guided access. Reference: Sharma PS, Padala SK, Gunda S, Koneru JN, Ellenbogen KA. Vascular complications during catheter ablation of cardiac arrhythmias: a comparison between vascular ultrasound guided access and conventional vascular access. J Cardiovasc Electrophysiol. 2016;27(10):1160-1166.

/sites/eplabdigest.com/files/articles/images/Salcedo_1.pdf