Abstract Ultrasound (US) guidance is increasingly used in invasive cardiac electrophysiology (EP) procedures for femoral vascular access. In this study, we assessed the occurrence of vascular access-related complications in EP procedures which were performed with the routine use of anatomical landmark (LM) versus US-guided vascular access. A total of 1119 consecutive EP procedures in 1012 patients performed in a two-year period from September 10, 2020 to September 10, 2022 were included.