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

Abstract

BackgroundFluoroscopy is conventionally performed for cardiac implantable electronic device (CIED) therapy and carries radiation drawback for both patients and medical workers. Recently, zero to minimal fluoroscopy (ZMF) approach is introduced to reduce radiation exposure of fluoroscopy. This study compares the feasibility and safety of ZMF approach to fluoroscopy for CIEDs therapy in adults.MethodA systematic literature search was conducted on PubMed, ScienceDirect, and Web of Science in March 2023. All observational or experimental studies comparing ZMF approach to fluoroscopy for adult CIEDs therapy were included. Reviews, case report/series, animal studies, and non‐English articles were excluded. The success rate, procedural time, fluoroscopy time, radiation dose, and complications rate were compared for each approach.ResultsSeven articles for permanent and three articles for temporary CIEDs were included for analysis. The success rate of ZMF for permanent CIEDs was similar to fluoroscopy method (OR: 0.77, 95% CI: 0.33–4.15). The procedural time of ZMF was similar to fluoroscopy for both permanent and temporary CIEDs (standardized mean difference [SMD]: 0.10, 95% CI: −0.35 to 0.55 and SMD: −0.71, 95% CI: −1.87–0.44, respectively). However, ZMF approach markedly reduced the fluoroscopy time and radiation exposure for permanent CIEDs (SMD: −1.80, 95% CI: −2.49 to −1.12 and SMD: −1.26, 95% CI: −2.24 to −0.29). The complication rate was similar for permanent CIEDs (OR: 1.08, 95% CI: 0.41–2.84), yet lowered for temporary CIEDs (OR: 0.34, 95% CI: 0.20–0.59).ConclusionZMF had similar success rate, procedural time, and sum complication rate for permanent CIEDs implantation with a significant reduction of fluoroscopy time and radiation exposure.

Clinical advantage of zero to minimal fluoroscopy for cardiac electronic device implantable

“…Luke et al, through a systematic literature review, demonstrated that ZMF yielded analogous success rates, procedural durations, and overall complication rates for permanent cardiac implantable electronic device (CIED) implantation, while markedly reducing fluoroscopy time and radiation exposure when juxtaposed with the traditional fluoroscopy method. 1 Nonetheless, several concerns have surfaced regarding the ZMF approach. Its purported advantage lies in abstaining from fluoroscopy, 1 yet it frequently relies on alternative modalities such as three-dimensional mapping systems.…”

“…Luke et al., through a systematic literature review, demonstrated that ZMF yielded analogous success rates, procedural durations, and overall complication rates for permanent cardiac implantable electronic device (CIED) implantation, while markedly reducing fluoroscopy time and radiation exposure when juxtaposed with the traditional fluoroscopy method. 1 …”

“…Nonetheless, several concerns have surfaced regarding the ZMF approach. Its purported advantage lies in abstaining from fluoroscopy, 1 yet it frequently relies on alternative modalities such as three‐dimensional mapping systems. An imperative requisite is the conduction of cost‐effectiveness analyses, employing measures like Quality‐Adjusted Life Years, to ascertain the comparative efficacy between these methodologies.…”

“…While the ZMF approach circumvents the use of contrast agents, 1 it is noteworthy that CIED implantation typically necessitates a mere 10–20 mL of contrast agent. Importantly, intravenous administration of contrast agents seldom incites contrast‐induced nephropathy.…”