Safety and feasibility of 3D-electroanatomical mapping-guided zero or near-zero fluoroscopy catheter ablation for pediatric arrhythmias: Meta-analysis

Background: Catheter ablation in the pediatric population using fluoroscopy has been known to cause adverse events. This study aims to assess the effectiveness and safety of zero fluoroscopy (ZF) and near-ZF-guided catheter ablation for the treatment of arrhythmias in the pediatric population.

Methods: The PubMed, Embase, and Cochrane library databases were searched and reviewed for relevant studies. Outcomes of interest include safety, short-term, and long-term effectiveness. We classified patients ≤21 years old who underwent ZF or near-ZF ablation with fluoroscopy time ≤1.5 min as our study group and patients within the same age range who underwent conventional fluoroscopy and/or near-ZF ablation with a mean fluoroscopy time >1.5 min as our control group. Both ZF and near-ZF ablation utilized 3D-electroanatomical mapping (3D-EAM).

Results: Ten studies composed of 2279 patients were included in this study. Total fluoroscopy time (MD -15.93 min, 95% CI (-22.57 - (-9.29), p < .001; I ² = 84%)) and total procedural time (MD -22.06 min, 95% CI (-44.39 - (-0.28), p < .001; I ² = 88%)) were significantly lower in the near-ZF group. Both ZF and near-ZF demonstrated a trend towards improved success rates compared to conventional fluoroscopy but did not achieve statistical significance for all subgroup analyses. Ablation in the study group also decreased incidence of complication compared to the control (RR 0.35; 95% CI (0.14-0.90); p = .03; I ² = 0%).

Conclusion: ZF and near-ZF ablation reduced the overall duration, compares in effectiveness, and shows a superior safety profile compared to control group.