Zero fluoroscopy catheter ablation for atrial fibrillation: a systematic review and meta-analysis

Abstract

IntroductionCatheter ablation for atrial fibrillation (AF) is the most frequently performed cardiac ablation procedure worldwide. The majority of ablations can now be performed safely with minimal radiation exposure or even without the use of fluoroscopy, thanks to advances in 3-dimensional electroanatomical mapping systems and/or intracardiac echocardiography. The aim of this study was to conduct a meta-analysis to compare the effectiveness of zero fluoroscopy (ZF) versus non-zero fluoroscopy (NZF) strategies for AF ablation procedures.MethodsElectronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of ZF vs. NZF approaches in patients undergoing catheter ablation for AF. We used a random-effects model to derive the mean difference (MD) and risk ratios (RR) with a 95% confidence interval (CI).ResultsOur meta-analysis included seven studies comprising 1,593 patients. The ZF approach was found to be feasible in 95.1% of patients. Compared to the NZF approach, the ZF approach significantly reduced procedure time [mean difference (MD): −9.11 min (95% CI: −12.93 to −5.30 min; p < 0.01)], fluoroscopy time [MD: −5.21 min (95% CI: −5.51 to −4.91 min; p < 0.01)], and fluoroscopy dose [MD: −3.96 mGy (95% CI: −4.27 to −3.64; p < 0.01)]. However, there was no significant difference between the two groups in terms of total ablation time [MD: −104.26 s (95% CI: −183.37 to −25.14; p = 0.12)]. Furthermore, there was no significant difference in the acute [risk ratio (RR): 1.01, 95% CI: 1.00–1.02; p = 0.72] and long-term success rates (RR: 0.96, 95% CI: 0.90–1.03; p = 0.56) between the ZF and NZF methods. The complication rate was 2.76% in the entire study population and did not differ between the groups (RR: 0.94, 95% CI: 0.41–2.15; p = 0.89).ConclusionThe ZF approach is a feasible method for AF ablation procedures. It significantly reduces procedure time and radiation exposure without compromising the acute and long-term success rates or complication rates.

Feasibility and safety of cavotricuspid isthmus ablation using exclusive intracardiac echocardiography guidance: a proof-of-concept, observational trial

“…In recent years, the use of EAMSs as an alternative visualization technique in electrophysiology procedures has gained popularity due to its potential to decrease procedural time and reduce or even completely eliminate radiation exposure. Numerous studies have confirmed the feasibility of near-zero and zero-fluoroscopy approaches for CTI ablation, including their successful application as an extension to pulmonary vein isolation procedures within a single session ( 5 , 15 – 23 ). In addition, the advent of visualizable steerable sheaths has yielded significant advancements in mitigating radiation exposure during catheter ablation procedures ( 24 ).…”

Comparison of intracardiac vs. transesophageal echocardiography for “one-stop” procedures of combined radiofrequency catheter ablation and left atrial appendage closure with the Watchman device in the treatment of atrial fibrillation

“…Considering the advantage of ICE, the total fluoroscopy time and fluoroscopy dose in the ICE group were less than those in the TEE group (P = 0.002, P = 0.015) in this study, which was consistent with previous studies (27). Zero-fluoroscopy "one-stop" procedures have become feasible using a combination of ICE and threedimensional electroanatomical mapping systems (28,29). Pericardial effusion could be detected by ICE before hemodynamic changes and be intervened with anticoagulation reversal and pericardiocentesis to prevent the occurrence of cardiac tamponade (25).…”

Comparison of pulmonary vein isolation using cryoballoon, high-power short-duration, and conventional radiofrequency ablation for atrial fibrillation: a propensity score-weighted study

“…Steerable sheaths help the operators improve contact and stability of the ablation catheter, leading to achieve efficient lesion formation for AF ablation. Recently, with the advent of visualizable steerable sheaths, RF-PVI is associated with minimal radiation exposure ( 42 , 43 ), and zero-fluoroscopy RF-PVI ( 44 ) showed equal efficacy and safety compared with traditional procedures ( 45 ). Therefore, future direction for AF ablation using cryoballoon and radiofrequency catheter possibly studies better rhythm outcomes, lower complication rates, reduced procedure time, and also reduced radiation exposure.…”