Irnizarifka Irnizarifka, Tristan Christopher D, Wijayanto Matthew A, Myrtha Risalina, Modesty Kyra, Rahma Annisa A, Budiono Enrico A, Rahman Awalil Rk, Hamka Muhammad F, Ilyas Muhana F
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.
Department of Cardiology and Vascular Medicine, Universitas Sebelas Maret Hospital, Sukoharjo, Indonesia.
Narra J. 2025 Aug;5(2):e2094. doi: 10.52225/narra.v5i2.2094. Epub 2025 Apr 24.
Catheter ablation has been the go-to treatment for ventricular arrhythmia, with traditional fluoroscopy-guided and non-zero fluoroscopy (NZF) catheter ablation posing high radiation risk for operators and patients. Zero-fluoroscopy technique offers elimination of radiation risk; however, its efficacy and safety in ventricular arrhythmia patients are not well explored. The aim of this study was to systematically evaluate the effectiveness, safety, and feasibility of zero-fluoroscopy ablation on ventricular arrhythmia patients. This study only included relevant studies comparing zero-fluoroscopy and NZF in ventricular arrhythmia ablation that were identified from Scopus, PubMed, and ScienceDirect (up to June 20, 2024). The quality of the study was assessed using the ROBINS-I tool, and the meta-analysis was conducted using a random-effect model. Out of 383 studies found, nine cohort studies were included with 1.408 patients. There was no significant difference in the acute procedural success rate of the zero-fluoroscopy and NZF (relative risk: 1.01; 95%CI: 0.95-1.07; =0.69), with a similar recurrence rate (=0.88; for four studies; n=374), and comparable procedural time (mean difference: -19.22 minutes; 95%CI: - 41.16-2.72; =0.09). Adverse events such as pericardial effusion, pseudoaneurysm, and hematoma were similar between zero-fluoroscopy and NZF. Overall, zero-fluoroscopy catheter ablation has demonstrated non-inferiority as a treatment option for ventricular arrhythmia ablation. As zero-fluoroscopy eliminates radiation risk without compromising procedural efficacy, zero-fluoroscopy has the potential to become a widely adopted approach for catheter ablation in ventricular arrhythmia.
导管消融一直是治疗室性心律失常的首选方法，传统的透视引导和非零透视（NZF）导管消融对术者和患者都有很高的辐射风险。零透视技术可消除辐射风险；然而，其在室性心律失常患者中的疗效和安全性尚未得到充分研究。本研究的目的是系统评价零透视消融治疗室性心律失常患者的有效性、安全性和可行性。本研究仅纳入了从Scopus、PubMed和ScienceDirect数据库（截至2024年6月20日）中检索到的比较零透视和NZF在室性心律失常消融中的相关研究。采用ROBINS-I工具评估研究质量，并使用随机效应模型进行荟萃分析。在检索到的383项研究中，纳入了9项队列研究，共1408例患者。零透视组和NZF组的急性手术成功率无显著差异（相对风险：1.01；95%置信区间：0.95-1.07；P=0.69），复发率相似（P=0.88；4项研究；n=374），手术时间相当（平均差值：-19.22分钟；95%置信区间：-41.16-2.72；P=0.09）。零透视组和NZF组心包积液、假性动脉瘤和血肿等不良事件相似。总体而言，零透视导管消融作为室性心律失常消融的一种治疗选择已显示出非劣效性。由于零透视消除了辐射风险且不影响手术疗效，零透视有可能成为室性心律失常导管消融中广泛采用的方法。
