Zero- and minimal fluoroscopic approaches during ablation of supraventricular tachycardias: A systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablations for cardiac arrhythmias are conventionally performed under fluoroscopic guidance. Using three dimensional electroanatomical mapping systems to guide these procedures, zero/minimal fluoroscopy (Z/MF) approaches became available. Purpose Our aim was to conduct a meta-analysis comparing these two different methods for the treatment of paroxysmal supraventricular tachycardias (SVT). Methods Electronic databases were searched and systematically reviewed for studies comparing procedural parameters and outcomes of conventional, fluoroscopy-guided vs. Z/MF approaches in patients undergoing EP procedures for SVTs. The random-effects model was used to derive mean difference (MD) and risk ratios (RR) with 95÷ confidence interval (CI). Results 24 studies involving 9,074 patients met our inclusion criteria. There were no differences between the groups in acute success (RR=1.00, 95÷ CI, 0.99–1.01; p=0.97) and long-term success rate (RR: 1.01, 95÷ CI, 1.00–1.03; p=0.13). Compared to the conventional method, Z/MF ablation significantly reduced fluoroscopic time (MD: -10.95 min (95÷ CI, -18.43 to -3.46 min; p<0.01)) and ablation time (MD: -25.23 s (95÷ CI: -42.04 to -8.43 s; p<0.01)). Procedure time (MD: 3.06 min (95÷ CI: -0.97 to 7.08; p=0.14)) and number of ablation applications (MD: 0.13 (95÷ CI: -0.86 to 1.11; p=0.80)) were not different between the groups. Complication rate was 1.59% in the entire study population and did not differ among the groups (RR: 0.68, 95÷ CI: 0.45–1.05; p=0.08). Conclusions Z/MF approach for the catheter ablation of SVTs is a feasible method that reduces radiation exposure and ablation time but does not compromise the acute and long-term success, or complication rates.