The use of minimal fluoroscopy for cardiac electrophysiology procedures: A meta‐analysis and review of the literature

Abstract

Background Conventional catheter ablation involves prolonged exposure to ionizing radiation, potentially leading to detrimental health effects. Minimal fluoroscopy (MF) represents a safer alternative, which should be explored. Data on the safety and efficacy of this technique are limited. Hypothesis Our hypothesis is that MF is of equal efficacy and safety to conventional catheter ablation with the use of fluoroscopy by performing a meta‐analysis of both randomized controlled trials (RCTs) and real‐world registry studies. Methods Pubmed and Embase were searched from their inception to July 2020 for RCTs, cohort and observational studies that assessed the outcomes of catheter ablation using a MF technique versus the conventional approach. Results Fifteen studies involving 3795 patients were included in this meta‐analysis. There was a significant reduction in fluoroscopy and procedural time with no difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50–1.10, p = .14), long‐term success (OR:0.92, 95% CI: 0.65–1.31, p = .38), arrhythmia recurrence (OR:1.24, 95% CI: 0.75–2.06, p = .97) or rate of complications. (OR:0.83, 95% CI: 0.46–1.48, p = .65). Additionally sub‐group analysis for those undergoing catheter ablation for atrial fibrillation (AF) did not demonstrate a difference in success or complication rates (OR:0.86, 95% CI: 0.30–2.42, p = .77). Multivariate meta‐regression did not identify the presence of moderator variables. Conclusion This updated meta‐analysis demonstrated an overall reduction in procedural and fluoroscopy time for those undergoing a minimal fluoroscopic approach. There was no significant difference in either acute or chronic success rates or complications between a MF approach and conventional approach for the management of all arrhythmias including those undergoing catheter ablation for AF.

Zero to minimal fluoroscopy for cardiac electronic device implantation: A systematic review and meta‐analysis

“…Many published articles reported the success of the ZMF approach for numerous cardiac procedures, such as catheter ablations and correction of congenital heart diseases. Arrhythmia termination using the ZMF approach (3D‐EAMS) was not inferior compared to conventional fluoroscopy 5,18,19 . Meanwhile, transcatheter correction under echocardiography guidance could also be done to treat atrial septal defect and patent ductus arteriosus 20,21 .…”

“…Arrhythmia termination using the ZMF approach (3D‐EAMS) was not inferior compared to conventional fluoroscopy. 5 , 18 , 19 Meanwhile, transcatheter correction under echocardiography guidance could also be done to treat atrial septal defect and patent ductus arteriosus. 20 , 21 Interestingly, the ZMF approach had also been performed for CIEDs implantation.…”

“…4 Zero-to-minimal fluoroscopy (ZMF) has been deemed as an alternative to fluoroscopy, as a meta-analysis demonstrated comparable success rates and complications but with less radiation exposure for catheter ablation procedures. 5 However, to our knowledge, no meta-analysis has been conducted to compare the ZMF approach to fluoroscopy for the implantation of CIEDs. Therefore, this meta-analysis was aimed to evaluate the feasibility and safety of the two approaches in navigating CIEDs implantation in adults.…”

Zero‐fluoroscopy ablation in patients with cardiac electronic implantable devices

“…The development of 3‐D mapping systems has allowed surgeons to perform ablation procedures with less radiation exposure 12 . Studies have demonstrated the safety of reduced or zero‐fluoro ablation for supraventricular arrhythmia 13–15 . Among such studies, a single‐center study by Razmania et al 14 showed no lead‐related complications in 52 patients with CIEDs who underwent zero‐fluoro ablation for various types of arrhythmias.…”

“…12 Studies have demonstrated the safety of reduced or zero-fluoro ablation for supraventricular arrhythmia. [13][14][15] Among such studies, a single-center study by Razmania et al 14 showed no lead-related complications in 52 patients with CIEDs who underwent zero-fluoro ablation for various types of arrhythmias. This suggested that at experienced centers, zero-fluoro ablation can be a safe option even in the presence of CIED leads.…”