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Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
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Zero to Minimal Fluoroscopy Approach for Conduction System Pacing: A Meta-Analysis.

Zixuan Xing1, Kexin Yang1, Gaigai Ma1

  • 1Department of Cardiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Pacing and Clinical Electrophysiology : PACE
|November 4, 2025
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Summary

Zero-to-minimal fluoroscopy (ZMF) for conduction system pacing (CSP) significantly reduces radiation exposure and procedure time. This approach maintains procedural safety and efficacy, making it a viable alternative to conventional fluoroscopy-guided methods.

Keywords:
conduction system pacingechocardiographyelectroanatomical mappingfluoroscopymeta‐analysis

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Procedures

Background:

  • Conventional fluoroscopy-guided conduction system pacing (CSP) presents challenges including prolonged procedure times and increased radiation exposure.
  • While zero-to-minimal fluoroscopy (ZMF) is a potentially safer alternative, robust evidence on its safety and efficacy is limited.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of the zero-to-minimal fluoroscopy (ZMF) approach for conduction system pacing (CSP).
  • To compare ZMF with conventional fluoroscopy-guided CSP in terms of procedural outcomes and lead performance.

Main Methods:

  • A systematic literature search was conducted across PubMed, Embase, and Web of Science for relevant randomized controlled trials and observational studies.
  • Comparative outcomes analyzed included procedural success, procedure time, fluoroscopy time, radiation dose, complication rates, and mid-term lead performance.

Main Results:

  • The meta-analysis included eight studies with 385 patients, comparing ZMF with conventional fluoroscopy for CSP.
  • ZMF demonstrated comparable procedural success rates and complication risks, with no significant difference in procedure time.
  • Crucially, ZMF significantly reduced fluoroscopy time and radiation exposure without compromising mid-term lead performance.

Conclusions:

  • The zero-to-minimal fluoroscopy (ZMF) approach for conduction system pacing (CSP) is effective and safe.
  • ZMF significantly lowers radiation exposure and procedure time compared to conventional fluoroscopy.
  • This method offers substantial clinical benefits, particularly for radiation-sensitive patient populations.