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

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.

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In 129 two-children cases, including 84 twin cases and 45 brother and sister cases, the probability of paternity of one or several men was calculated, applying the method of Hummel and Schulte-Mönting. With this method the whole information, given by the blood group results, is used. Because of this, the achieved values of probability in most of the cases are higher than the values achieved using the Essen-Möller formula, in which the relation between the children is not taken into account.