Retrograde aortic access for ventricular arrhythmia ablation: A novel plug and suture strategy for vascular closure

The retrograde aortic (RA) approach is frequently utilized for catheter ablation targeting ventricular arrhythmia (VA).Various sheath types may be used for RA access, including deflectable and nondeflectable sheaths with larger diameters.Deflectable sheaths offer an additional pivot point, potentially enhancing stability and contact in regions with challenging catheter positioning, especially with irregular anatomy.However, registry studies have demonstrated that the risk of complications during VA ablations is substantial, with a significant proportion attributable to vascular access. 1 Consequently, there is a need for novel hemostasis methods following sheaths removal, especially when using deflectable sheaths with large-bore access, to reduce vascular complications and improve patient outcomes.Current options for achieving hemostasis following femoral arterial access include manual compression and the use of vascular closure devices (VCDs).Insights from structural heart interventions, such as transcatheter aortic valve replacement, have contributed to advancements in safe RA access techniques.Recently, a novel technique combining a plug-based with a suture-based VCD has been described. 2This novel VCD strategy has not been tested in the VA ablation population, in which anticoagulation is uninterrupted.This study aimed to evaluate the safety and efficacy of the novel VCD strategy for large-bore vascular access following transfemoral VA ablation.