Zero or low fluoroscopy approaches for AF ablation resulted in similar 12-month AF recurrence risk compared to conventional fluoroscopy (OR 1.343; 95% CI 0.771-2.340; P=0.297).
Meta-Analysis (n=2,228)
Yes
Does a zero or low fluoroscopy approach improve procedural metrics without compromising efficacy and safety compared to conventional fluoroscopy in patients undergoing PVI for AF?
Low or zero fluoroscopy approaches for AF ablation significantly reduce radiation exposure and procedure time without compromising safety or 12-month efficacy.
Odds Ratio: 1.343 (95% CI 0.771–2.34)
p-value: p=.297
Abstract Introduction Radiation exposure during catheter ablation procedures is a significant hazard for both patients and operators. Atrial fibrillation (AF) ablation procedures have been historically associated with higher fluoroscopy usage than other electrophysiology procedures. Recent efforts have been made to reduce dependence on fluoroscopy during pulmonary vein isolation (PVI) ablation procedures using alternative techniques. Methods We performed a meta‐analysis of studies comparing zero or low fluoroscopy (LF) vs conventional fluoroscopy (CF) approaches for AF ablation. Outcomes of interest included acute and 12‐month procedural efficacy, safety, procedure duration, fluoroscopy time, and dose area product. Aggregated data were analyzed with random‐effects models, using a Bayesian hierarchical approach. Results A total of 2228 participants (LF, n = 1190 vs CF, n = 1038) from 15 studies were included in the meta‐analysis. Risk of AF recurrence in 12 months (odds ratio OR, 95% confidence interval 95% CI = 1.343 0.771‐2.340; P = .297), redo‐ablation procedures (OR 95% CI = 0.521 0.198‐1.323; P = .186), and procedural complications (OR 95% CI = 0.99 0.485‐2.204; P = .979) were similar between LF‐ and CF‐ablation groups. In comparison to CF ablation, LF ablation led to shorter procedure duration (weighted mean differences WMDs 95% CI = −14.6 minutes −22.5 to −6.8; P < .001), fluoroscopy time (WMD 95% CI = −8.8 minutes −11.9 to −5.9; P < .001), and dose area product (WMD 95% CI = −1946 mGy/cm 2 −2685 to 1207; P < .001). Conclusion LF approaches have similar clinical efficacy and safety as CF approaches for PVI. LF approaches are associated with shorter procedure time, fluoroscopy usage, and dose area product during PVI.
Huang et al. (Mon,) conducted a meta-analysis in Atrial fibrillation (n=2,228). Zero or low fluoroscopy (LF) approaches vs. Conventional fluoroscopy (CF) approaches was evaluated on Risk of AF recurrence in 12 months (OR 1.343, 95% CI 0.771-2.340, p=.297). Zero or low fluoroscopy approaches for AF ablation resulted in similar 12-month AF recurrence risk compared to conventional fluoroscopy (OR 1.343; 95% CI 0.771-2.340; P=0.297).