Zero-fluoroscopy guided AF ablation significantly reduced radiation dose (MD -31.39 mGy; 95% CI -37.44 to -25.35; p<0.00001) compared to conventional fluoroscopy, with similar 12-month recurrence.
Meta-Analysis (n=1,998)
Does zero-fluoroscopy guided ablation reduce radiation exposure and maintain efficacy compared to conventional fluoroscopy in adults undergoing atrial fibrillation ablation?
Zero-fluoroscopy guided atrial fibrillation ablation significantly reduces radiation exposure without compromising procedural safety, duration, or 12-month efficacy compared to conventional fluoroscopy.
Effect estimate: MD -31.39 mGy (95% CI -37.44 to -25.35)
p-value: p=<0.00001
ABSTRACT Background and Aims Atrial fibrillation (AF) ablation traditionally relies on fluoroscopy, exposing both patients and operators to ionizing radiation and lead apron‐related occupational harm. Contemporary electroanatomical mapping and intracardiac echocardiography now enable zero‐fluoroscopy (ZF) workflows, but comparative evidence regarding their safety and effectiveness remains limited. This study evaluated radiation exposure, procedural safety, procedural duration, and 12‐month atrial arrhythmia‐free recurrence after ZF versus conventional fluoroscopy (CF)‐guided AF ablation. Methods A systematic review and meta‐analysis were conducted in accordance with PRISMA. PubMed, MEDLINE, Embase, and Cochrane were searched from January 1, 2014 to 2025 2, March for comparative studies comparing ZF with CF‐guided atrial fibrillation ablation in adults. Primary outcomes were radiation exposure, peri‐procedural complications, and 12‐month atrial arrhythmia‐free recurrence. Procedure duration was assessed as a secondary endpoint. Random‐effects models were used to pool mean differences and odds ratios, with 95% confidence intervals. Results Twelve studies involving 1998 patients were included, comprising two randomized controlled trials and ten observational cohorts. Of these, 1098 underwent ZF‐guided ablations, and 900 underwent CF‐guided ablations. Compared with CF‐guided ablation, ZF‐guided ablation significantly reduced fluoroscopy time (MD −6.94 min, 95% CI −11.84 to −2.04, p = 0.006) and radiation dose (MD −31.39 mGy, 95% CI −37.44 to −25.35, p < 0.00001). There was no significant difference in 12‐month freedom from atrial arrhythmia recurrence (OR 0.98, 95% CI 0.62 to 1.57, p = 0.74) or overall procedural complications (OR 0.73, 95% CI 0.35 to 1.55, p = 0.42). Procedure duration was not significantly different between groups (MD −7.16 min, 95% CI −15.38 to 1.06, p = 0.20). Conclusion ZF‐guided ablation for AF substantially reduces radiation exposure without evidence higher procedural complication, 12‐month freedom from atrial arrhythmia recurrence or procedure duration compared with CF‐guided AF ablation. These findings support broader adoption of ZF‐guided ablation in centres with appropriate imaging and mapping expertise, although the certainty of evidence remains limited by heterogeneity and the predominance of observational data included in this study.
Shawki et al. (Thu,) conducted a meta-analysis in Atrial fibrillation (n=1,998). Zero-fluoroscopy (ZF) guided ablation vs. Conventional fluoroscopy (CF) guided ablation was evaluated on Radiation dose (MD -31.39 mGy, 95% CI -37.44 to -25.35, p=<0.00001). Zero-fluoroscopy guided AF ablation significantly reduced radiation dose (MD -31.39 mGy; 95% CI -37.44 to -25.35; p<0.00001) compared to conventional fluoroscopy, with similar 12-month recurrence.