Zero-Fluoroscopy Ablation Methods for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Atrial fibrillation (AF) ablation traditionally uses fluoroscopy, posing radiation risks to patients and operators.
• Zero-fluoroscopy (ZF) workflows utilizing advanced mapping and imaging offer an alternative.
• Comparative data on ZF versus conventional fluoroscopy (CF) AF ablation safety and efficacy is limited.

Purpose of the Study:

• To evaluate and compare the safety and effectiveness of ZF-guided versus CF-guided AF ablation.
• Primary outcomes included radiation exposure, procedural complications, and 12-month arrhythmia recurrence.
• Secondary endpoint was procedure duration.

Main Methods:

• Systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched PubMed, MEDLINE, Embase, and Cochrane (Jan 2014 - Mar 2025).
• Included 12 studies (1998 patients): 2 RCTs, 10 observational cohorts comparing ZF and CF AF ablation.

Main Results:

• ZF ablation significantly reduced fluoroscopy time (MD -6.94 min) and radiation dose (MD -31.39 mGy) versus CF.
• No significant differences observed in 12-month arrhythmia-free recurrence (OR 0.98) or overall complications (OR 0.73).
• Procedure duration was comparable between ZF and CF groups (MD -7.16 min).

Conclusions:

• ZF-guided AF ablation substantially lowers radiation exposure without compromising safety, efficacy, or procedure length compared to CF.
• Findings support broader ZF adoption in centers with expertise in advanced imaging and mapping.
• Evidence certainty is limited by study heterogeneity and reliance on observational data.