Vascular access and closure management for electrophysiological interventions in 2025: a Clinical Consensus Statement of the European Heart Rhythm Association and the European Association of Percutaneous Cardiovascular Interventions of the ESC, and the ESC Working Group on Cardiovascular Surgery

A standardized step-by-step approach to vascular access during electrophysiological procedures: Begin by identifying patients at higher risk for vascular complications and consider alternative access routes in cases of inferior vena cava interruption. Allow the patient to drink clear fluids and adopt an uninterrupted anticoagulation strategy when feasible. Choose the access site based on procedural needs and patient anatomy, giving preference to ultrasound-guided puncture to improve accuracy and reduce complications. At the end of the procedure, select the most appropriate closure technique – manual compression, figure-of-eight suture, or a vascular closure device – based on access site, sheath size, and patient-specific factors.