Zero- or minimal-fluoroscopy vs conventional fluoroscopy in catheter ablation of supraventricular tachycardias: An updated systematic review and meta-analysis

Background Catheter ablation is the treatment of choice for supraventricular tachycardias. Conventional fluoroscopy (CF) enables real-time guidance but exposes patients and staff to ionizing radiation. Zero- (ZF) or minimal-fluoroscopy (MF) approaches are primarily enabled by electroanatomic mapping, with adjunctive tools such as intracardiac echocardiography used selectively when clinically indicated, to reduce radiation. Objective This study aimed to evaluate the efficacy and safety of ZF/MF ablation compared with CF for supraventricular tachycardias. Methods We performed a systematic review and meta-analysis of randomized controlled trials and observational studies comparing ZF/MF with CF ablation. The primary outcomes were acute and long-term success. Long-term success was defined as the absence of arrhythmia recurrence during the follow-up period. Results 34 studies (5 randomized controlled trials, 29 observational; 11,635 patients) were included. Acute success was similar (risk ratio [RR] 1.00; 95% confidence interval [CI] 0.99–1.01; P = .94), whereas long-term success favored ZF/MF (RR 1.02; 95% CI 1.00–1.03; P = .023). Complications were comparable (RR 0.65; 95% CI 0.26–1.61; P = .35). ZF/MF significantly reduced fluoroscopy time (mean difference [MD] −13.75 minutes; 95% CI −16.49 to −11.02; P < .01) and dose–area product (MD −1511.98 cGy·cm 2 ; 95% CI −2358.44 to −665.53; P < .01). Procedure duration was slightly longer with ZF/MF (MD +4.47 minutes; 95% CI 0.19–8.75; P = .04). Conclusion ZF/MF ablation provides equivalent acute efficacy, marginal improvement in long-term success, and markedly reduces radiation exposure without increasing complications. These findings support ZF/MF as a safe and effective alternative to CF, with particular relevance for minimizing radiation exposure in vulnerable populations.