Meta‐analysis of pulmonary vein isolation ablation for atrial fibrillation conventional vs low‐ and zero‐fluoroscopy approaches

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), redoablation 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. K E Y W O R D S atrial fibrillation, catheter ablation, fluoroscopy, pulmonary vein isolation

Comparison between minimal fluoroscopy and conventional approaches for visually guided laser balloon pulmonary vein isolation ablation

“…In a recently published meta‐analysis of 15 studies (n = 2228) comparing low and conventional fluoroscopy approaches for RF PVI, clinical efficacy and safety was found to be similar between the low and conventional fluoroscopy arms. However, low fluoroscopy ablation procedures were associated with lower total fluoroscopy time, DAP, and even shorter procedure time 18 …”

Impact of the combined use of intracardiac ultrasound and a steerable sheath visualized by a 3D mapping system on pulmonary vein isolation

“…The 3D‐EAM and ICE have enabled a zero or near‐zero fluoroscopy PVI with a favorable efficacy and safety 6,13,14 . However, the zero or near‐zero fluoroscopy ablation still requires experienced skills.…”

“…This result suggested that major complications may not increase during a lesser fluoroscopy PVI with a visualized sheath. However, a further large‐scale study would be warranted to verify the clinical outcomes because of the rate of major complications of 0–7% in other research 14 . The price of the conventional and novel steerable sheaths is approximately equal in Japan, but the former might be lower than the latter in other countries.…”

Visualizable vs. standard, non-visualizable steerable sheath for pulmonary vein isolation procedures: Randomized, single-centre trial

“…Based on the results of the meta-analysis performed by Huang et al, comparing conventional fluoroscopy vs. low/zero-fluoroscopy PVI procedures, similar clinical efficacy and safety can be reached by the adoption of alternative imaging modalities such as 3D EAM systems, force-sensing ablation catheters and ICE. Moreover, low/zero-fluoroscopy approach was associated with shorter procedure time besides reduced fluoroscopy time and exposure ( 20 ). Visualizable SS was not used in either involved studies, however, considering the available scientific data, application of these types of SSs could help in the feasibility of the low/zero-fluoroscopy approach and improve procedural outcomes of PVI procedures.…”