Venous Thrombosis after Electrophysiology Procedures: A Systematic Review

Background

Femoral venous access for catheter introduction represents the cornerstone of electrophysiology (EP) procedures. Limited data are available regarding post-procedure venous thromboembolism. The aim of this systematic review is to determine the incidence of deep vein thrombosis (DVT) and pulmonary embolus (PE) associated with femoral vein catheterization during EP procedures.

Methods

An electronic search was conducted for studies documenting the incidence of DVT and PE after EP procedures. Studies were classified as atrial fibrillation (AF) or non-AF ablation procedures.

Results

2864 studies were evaluated, of which 16 were included in the analysis. The incidence of DVT after AF and non-AF ablations reaches as high as 0.33% and 2.38% respectively, with a pooled incidence of 0% (95% CI [0 – 0.0003]) and 0.24% (95% CI [0.08 – 0.39]). The incidence of PE was 0.29% after AF ablation and ranged from 0% to 1.67% for non-AF procedures; pooled incidence after non-AF ablations was 0.12% (95% CI [0 – 0.25%]). Asymptomatic DVT was documented in up to 21.2% of patients. Hematomas occurred in 1.05% of AF ablations (95% CI [0.30 – 1.8%]) and 0.3% of non-AF ablations (95% CI [0.09 – 0.51%]).

Conclusions

A lower incidence of symptomatic DVT and PE was observed after AF ablation as opposed to non-AF ablations, likely due to the use of routine peri-procedural anticoagulation. Asymptomatic DVTs appear to be common although their significance is unclear. Future studies are required to weigh the risk of hematoma against the risk of venous thromboembolism associated with the use of prophylactic anticoagulation after non-AF ablation procedures.

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