Zero-fluoroscopy catheter ablation may provide similar safety and efficacy outcomes compared with fluoroscopy-guided and nonzero-fluoroscopy catheter ablation in patients with ventricular arrhythmias, according to a systematic review and meta-analysis.
In the analysis, investigators analyzed nine cohort studies involving 1,408 patients with ventricular arrhythmias undergoing catheter ablation. They used the Scopus, PubMed, and ScienceDirect databases through June 20, 2024, to identify studies comparing zero-fluoroscopy (ZF) with nonzero fluoroscopy (NZF) approaches. The investigators performed the meta-analysis using a random-effects model. Study outcomes included acute procedural success, recurrence rate, procedural duration, and safety profiles.
Across the eight studies reporting acute procedural success, pooled estimates indicated no statistically significant difference between the ZF and NZF techniques, though two studies showed that the ZF approach had slightly lower acute procedural success rates compared with the NZF approach.
Recurrence outcomes, reported in seven of the studies included in the analysis, were also comparable between the ZF and NZF techniques; however, the patients in the NZF group showed slightly higher recurrence rates compared with those in the ZF group. Follow-up periods ranged from months to several years, with no consistent advantage for either approach.
Further, eight studies demonstrated that procedural duration varied between the ZF and NZF techniques. Six studies, four of which were statistically significant, reported shorter procedures with ZF, whereas two studies showed longer times but without statistical significance. Overall, pooled findings revealed no statistically significant difference in this metric.
The investigators reported that sfety outcomes were similar between both groups. No peri- or postprocedural mortality was reported. Rates of pericardial effusion, pseudoaneurysms, and hematomas were comparable between the ZF and NZF approaches, while other complications were infrequent and not consistently associated with either approach.
The investigators noted that outcomes may vary depending on arrhythmia origin and procedural complexity. For instance, ventricular arrhythmias arising from anatomically complex regions, such as the septal anterior distal or septal posteriod proximal ventricular sites, were associated with higher recurrence rates.
Key limitations included the observational design of all included studies, variability in follow-up duration, and heterogeneity in procedural techniques and operator experience. The analysis didn't consistently differentiate arrhythmia subtypes or etiologies, which may have influenced outcomes.
Overall, the findings suggested that ZF ablation may be a non-inferior alternative to fluoroscopy-guided procedures without compromising measured outcomes while eliminating radiation exposure.
“[Z]ero-fluoroscopy catheter ablation has demonstrated non-inferiority as a treatment option for ventricular arrhythmia ablation,” wrote lead study author Irnizarifka Irnizarifka, of the Department of Cardiology and Vascular Medicine in the Faculty of Medicine at the Universitas Sebelas Maret, and colleagues.
The study authors reported no conflicts of interest and no external funding.
Source: Narra J