NONFLUOROSCOPIC CATHETER-GUIDED VERSUS FLUOROSCOPICALLY GUIDED CATHETER ABLATION PROCEDURES: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

BACKGROUND: Although previous studies have showed that nonfluoroscopic catheter-guided systems (NCGS) reduce Xray exposure compared to fluoroscopically guided procedures, conclusions regarding effectiveness and safety are inconsistent and may vary according to arrhythmia type. In light of their high cost, a systematic approach to resolve these discrepancies is necessary. METHODS: A meta-analysis of prospective randomized studies. A computerized systematic search of EMBASE, Medline and the Cochrane Controlled Trials register was done, using the search terms “catheter ablation” and “mapping” (19905/2010). Abstracts from annual scientific meetings (20052010) were searched manually. The outcomes of interest were: acute and chronic success, fluoroscopic, ablation and procedure time, radiation dose (RD), and rates of complications. The random effects model of DerSimonian and Laird was used. Summary estimates for continuous variables were reported as standardized difference in the means, while odds ratios (OR) were reported for dichotomous variables. An overall analysis was done pooling all identified studies, in addition to stratified analyses per arrhythmia subgroup. RESULTS: Thirteen prospective randomized control studies were identified, involving 1292 patients. NCGS were used in 666 patients (472 Carto, 168 Ensite, 26 LocaLisa) for ablating AVNRT, AVRT, atrial flutter (AFL), atrial fibrillation (AF), RVOT PVCs or ischemic VT. Acute and follow-up success rates were similar both overall (P 0.75 and 0.27, respectively) and per arrhythmia. Fluoroscopic time was shorter with NCGSboth overall and for AFL and SVT (P 0.001 each). Overall ablation and procedure times were not statistically different (P 0.15, 0.4, respectively). Overall RD was not different (P 0.068), but for AFL and SVT it was significantly less (P 0.002). A sensitivity analysis for overall RD excluding AF ablations using CartoMerge did show significant reduction with NCGS (P 0.001). Minor and major complication rates were similar both overall (P 0.3 each) and per specific arrhythmia. CONCLUSION: The success rates, overall procedure time and complication rates were similar between fluoroscopic and nonfluoroscopic guided ablation procedures (in 1292 procedures reported to the date). Fluoroscopic time and radiation dose were significantly reduced for ablation of AFL and SVT when NCGS were used. Canadian Institutes of Health Research (CIHR), ORF 348 A FEASIBILITY PILOT STUDY TO IDENTIFY SELECT PULMONARY VEIN ANTRAL SINUS RHYTHM ELECTROGRAMS AS TARGETS FOR CATHETER ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION USING 3D ELECTROANATOMICAL MAPPING