Key result
Zero/low-fluoroscopy pulsed-field ablation achieves ~100% acute success with low complication rates.
Why the study?
The efficacy and safety of pulsed-field ablation with zero/low-fluoroscopy approach is unclear with previous evidence limited to thermal techniques.
Does a zero/low-fluoroscopy pulsed-field ablation approach provide high acute success and safety in patients undergoing ablation?
Meta-Analysis (n=1,005)
Does a zero/low-fluoroscopy pulsed-field ablation approach provide high acute success and safety in patients undergoing ablation?
Answers are grounded in this paper and cite their sources.
A zero/low-fluoroscopy approach for pulsed-field ablation appears technically feasible and safe, achieving a 100% acute success rate in pooled observational data.
BACKGROUND: The efficacy and safety of pulsed-field (PFA) ablation with zero/low-fluoroscopy (ZF/LF) approach is unclear with previous evidence limited to thermal technique. METHODS: PubMed, Embase, Cochrane Central, were systematically searched for studies reporting outcomes of ZF approach with PFA. Proportions were pooled with a random-effects model using an arcsine transformation to adjust for extreme values. RESULTS: 14 observational studies were included, comprising a total of 1005 patients who underwent a reduced fluoroscopy pulsed field ablation approach. The pooled acute success rate was 100% (95% CI: 1.0–1.0; I2 = 0%) with a low arrhythmia recurrence rate in the descriptive analysis. The prevalence of complications was also low. Furthermore, the mean procedure time was 80.9 min (95% CI 64.86–97.11; I2 = 99.4%) and the mean total left atrial dwell time was 46 min (95% CI 32.0–61.5; I2 = 96.9%). CONCLUSION: In this systematic review and meta-analysis, PFA ZF/LF approach demonstrates technical feasibility and favorable safety profile in selected observational studies.
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Erzinger et al. (2026) conducted a meta-analysis in Arrhythmia (n=1,005). Zero/low-fluoroscopy pulsed-field ablation was evaluated on Acute success rate (95% CI 1.0-1.0). A zero/low-fluoroscopy pulsed-field ablation approach achieved a pooled acute success rate of 100% (95% CI 1.0-1.0) with low complication and arrhythmia recurrence rates.
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