Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta‐analysis

Abstract

Introduction Catheter placement and stability are well‐known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter–tissue contact. The purpose of this systematic review and meta‐analysis is to see if employing a SS influences procedure outcome. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow‐up. The secondary outcomes were the procedure‐related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random‐effects model. Results A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09–1.29; p < .001). Both techniques had similar rate for procedural‐related complication (RR: 1.09, 95% CI 0.50–2.39; p = .83). The SS strategy had a shorter procedure time (MD −10.6 [min], 95% CI −20.97, −0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group. Conclusions The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.

Identification of epicardial connections can improve the success rate of first-pass right pulmonary vein isolation

“…PVI is the cornerstone of treatment of AF ablation. Improvements in 3-dimensional mapping systems, 9 , 10 steerable sheaths, 11 and radiofrequency systems 12 have improved the rate of successful PVI compared with previous methods. Even when the latest radiofrequency systems are used, achieving first-pass PVI can be difficult.…”

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

“…During these procedures, transseptal sheaths are routinely used to reduce procedural time and improve acute and long-term success rate. SSs can improve the contact and stability of the ablation catheter, thus were found superior compared to fixed sheaths ( 12 ).…”

The Fluoroless Future in Electrophysiology: A State-of-the-Art Review

“…On the other hand, intracardiac and thoracic impedance, as well as the patient's movements during the procedure, can affect the map reconstruction and significantly prolong procedure times [40,41]. The employment of steerable catheters to improve ablation catheter handling and tissue contact, leading to reduced ablation time and high-quality lesions, is constantly increasing, particularly during pulmonary vein (PV) isolation [42]. The recent production of a new generation of steerable catheters that can be integrated with EAM systems and, therefore, visualized on the 3D map provided a significant optimization in the procedure workflow [43].…”