Zero fluoroscopy for cardiac arrhythmia ablation showed no significant difference in acute procedure success (OR 1.10; 95% CI 0.75-1.59) compared to conventional or low fluoroscopy.
Meta-Analysis (n=6,052)
Does a zero fluoroscopy approach improve acute procedure success, recurrence-free survival, complications, and procedure times in patients undergoing cardiac arrhythmia ablations compared to conventional/low fluoroscopy?
A zero fluoroscopy approach for cardiac arrhythmia ablation yields comparable acute success, recurrence-free survival, complication rates, and procedure times to conventional fluoroscopy.
Odds Ratio: 1.1 (95% CI 0.75–1.59)
BACKGROUND: Radiofrequency catheter ablation for cardiac arrhythmias has traditionally been guided by fluoroscopy. Fluoroscopy exposes the patient, operator, and staff to ionizing radiation which has no safe dose void of stochastic and deterministic biologic risks. Zero fluoroscopy (ZF) approaches for catheter ablation have been advocated to eliminate these risks. We conducted a meta-analysis comparing acute procedure success, recurrence-free survival, complications, and procedure times between the approaches. METHODS: We conducted a literature search from inception through December 2020 in the databases of EMBASE and MEDLINE. We included randomized controlled trials and cohorts that compared the outcomes of interest in ZF and conventional/low fluoroscopy (CF/LF) approaches. The outcomes sought were acute procedure success, recurrence-free survival, complications, and procedure times. Effect estimates were combined, using the random-effects, generic inverse variance method of DerSimonian and Laird. RESULTS: Sixteen studies from 2013 to 2020, including 6052 patients (2219 ZF, 3833 CF/LF) were included. There were no significant differences in acute procedure success rate (odds ratio OR: 1.10, 95% confidence interval CI: 0.75-1.59), recurrence-free survival (OR: 1.08, 95% CI: 0.78-1.49), periprocedural complication rate (OR: 0.72, 95% CI: 0.45-1.16), or total procedure time (weighted mean difference 2.32 min, 95% CI: -2.85-7.50) between ZF and CF/LF approaches, respectively. Overall, only 1.26% of patients crossed over from ZF to CF/LF arm. CONCLUSIONS: Periprocedural and postprocedural outcomes with a ZF approach compared favorably with traditional fluoroscopic guidance without increasing procedural times. As comfort with ZF grows, coupled with evolving mapping technologies, this method has potential to become the standard approach for catheter ablation.
Kanitsoraphan et al. (Tue,) conducted a meta-analysis in cardiac arrhythmias (n=6,052). Zero fluoroscopy (ZF) approach vs. Conventional/low fluoroscopy (CF/LF) approach was evaluated on Acute procedure success rate (OR 1.10, 95% CI 0.75-1.59). Zero fluoroscopy for cardiac arrhythmia ablation showed no significant difference in acute procedure success (OR 1.10; 95% CI 0.75-1.59) compared to conventional or low fluoroscopy.