Femoral Vein Hemostasis After Ablation for Atrial Fibrillation With Manual Pressure Versus a Figure of 8 Suture

Patients who undergo ablation for AF typically have 2 sheaths placed in each groin, including
a large sheath when the Cryo Balloon is used for pulmonary vein isolation. During the
procedure, heparin is administered to maintain a target ACT > 300 seconds. At the conclusion
of the procedure, the venous sheaths are removed and hemostasis is obtained. There are at
least 2 ways of obtaining hemostasis after venous access. In the manual hemostasis approach,
an ACT is checked and protamine is administered. The ACT is rechecked 20" later, and if < 220
msec, the sheaths are pulled and hemostasis is achieved with manual pressure (Manual
Hemostasis Group). Another approach is to place a Figure of 8 suture around the sheaths in
each groin to achieve hemostasis as the sheaths are removed, and therefore obviate the need
for assessment of the ACT, protamine administration, and manual pressure (Figure of 8 Group).