Zero fluoroscopy approach versus fluoroscopy approach for cardiac arrhythmia ablations: A systematic review and meta‐analysis

Abstract

Background Radiofrequency catheter ablation for cardiac arrhythmias has traditionally been guided by fluoroscopy. Fluoroscopy exposes the patient, operator, and staff to ionizing radiation which has no safe dose void of stochastic and deterministic biologic risks. Zero fluoroscopy (ZF) approaches for catheter ablation have been advocated to eliminate these risks. We conducted a meta‐analysis comparing acute procedure success, recurrence‐free survival, complications, and procedure times between the approaches. Methods We conducted a literature search from inception through December 2020 in the databases of EMBASE and MEDLINE. We included randomized controlled trials and cohorts that compared the outcomes of interest in ZF and conventional/low fluoroscopy (CF/LF) approaches. The outcomes sought were acute procedure success, recurrence‐free survival, complications, and procedure times. Effect estimates were combined, using the random‐effects, generic inverse variance method of DerSimonian and Laird. Results Sixteen studies from 2013 to 2020, including 6052 patients (2219 ZF, 3833 CF/LF) were included. There were no significant differences in acute procedure success rate (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 0.75–1.59), recurrence‐free survival (OR: 1.08, 95% CI: 0.78–1.49), periprocedural complication rate (OR: 0.72, 95% CI: 0.45–1.16), or total procedure time (weighted mean difference 2.32 min, 95% CI: −2.85–7.50) between ZF and CF/LF approaches, respectively. Overall, only 1.26% of patients crossed over from ZF to CF/LF arm. Conclusions Periprocedural and postprocedural outcomes with a ZF approach compared favorably with traditional fluoroscopic guidance without increasing procedural times. As comfort with ZF grows, coupled with evolving mapping technologies, this method has potential to become the standard approach for catheter ablation.

Efficacy and safety of zero‐fluoroscopy ablation of ventricular arrhythmias originating from the right ventricular outflow tract: Comparison with fluoroscopy‐guided ablation without a three‐dimensional electroanatomic mapping system

“…Although the sub‐analysis on the efficacy and safety of the ZF approach was not noted in the subgroup undergoing ablation for RVOT VAs, the study demonstrated that using 3D EAM for completely ZF approach is as safe and efficient as the fluoroscopy approach for the ablation of idiopathic VAs 11 . In a systematic review and meta‐analysis of ZF approach versus fluoroscopy approach for cardiac arrhythmia ablations published in 2021, the subgroup analysis of VAs ablation presented no significant differences in acute procedure success rate, recurrence‐free survival, periprocedural complication rate, or total procedural time between ZF and fluoroscopy approach 17 …”

“…11 In a systematic review and meta-analysis of ZF approach versus fluoroscopy approach for cardiac arrhythmia ablations published in 2021, the subgroup analysis of VAs ablation presented no significant differences in acute procedure success rate, recurrencefree survival, periprocedural complication rate, or total procedural time between ZF and fluoroscopy approach. 17 RVOT VAs are frequently idiopathic of origin. 1,2 However, some…”

Case series of catheter‐based arrhythmia ablation in 13 pregnant women

“…15 The average effective dose is 3.2 mSv during EPSs and 15.2 mSv during catheter ablation, although this can be reduced to zero using EAMs. 14 In a recently published meta-analysis, Kanitsoraphan et al 16 found that zerofluoroscopic catheter ablation of arrhythmias is as effective and safe as conventional catheter ablation.…”

Efficacy and Safety of Nonfluoroscopic Approach During Catheter Ablation of Ventricular Tachycardias

“…Переход из группы нефлюороскопической абляции в группу с применением рентгеноскопии был осуществлен только у 1,26 % пациентов. Согласно полученным результатам, не выявлено достоверного увеличения продолжительности процедуры без использования флюороскопии по сравнению со стандартной методикой (средневзвешенная разница 2,32 мин; 95 % доверительный интервал -ДИ -2,85-7,50), а также не регистрировались статистически значимые различия по частоте развития осложнений (отношение шансов -ОШ 0,72; 95 % ДИ 0,45-1,16), неэффективности процедуры (ОШ 1,10; 95 % ДИ 0,75-1,59) или рецидивов нарушений ритма [18].…”

“…Проведенные нами вмешательства без использования рентгеноскопии у 20 пациентов с ЖТ не сопровождались развитием клинически значимых осложнений, применения флюороскопии не потребовалось ни в одном случае. Использование ВС-ЭхоКГ позволило провести качественное картирование, и длительность процедуры существенно не отличалась от таковой при выполнении подобных вмешательств [18,19]. В приведенный выше метаанализ вошло всего 2 исследования, посвященных КА ЖТ, с участием 254 пациентов без использования флюороскопии и 369 -с флюороскопией.…”