Outcomes of patients undergoing catheter ablation to treat atrial fibrillation using zero-fluoroscopy vs conventional approach

Abstract Introduction The utilization of zero-fluoroscopy and reduced fluoroscopy strategies in catheter ablation (CA) for atrial fibrillation (AF) is increasing. This aims to minimize radiation exposure and associated adverse effects for operators, patients, and laboratory staff. Objective We aimed to define the freedom from atrial arrhythmias in patients undergoing CA employing a zero-fluoroscopy approach compared to the conventional fluoroscopic approach. Methods Prospective, observational, multicenter registry. We enrolled patients with paroxysmal (PAF) and persistent (PsAF) and a minimum 12-month follow-up. Additional analysis classifying groups in conventional fluoroscopy (>1 minute), zero-fluoroscopy, or very low fluoroscopy (<1 minute) were performed. The primary efficacy outcome was freedom from atrial arrhythmias. Results We included 7,196 patients. The mean age was 66.7 years, females represented 39.8% of the cohort. Ablation was performed to treat PAF in 61.9% and psAF in 38.1%. A zero-fluoroscopy approach was chosen in 4,874 patients (67.7%), 2,322 (32.3%) used fluoroscopy, and 922 (12.8%) patients were utilized with very low fluoroscopy. Freedom from atrial arrhythmias after one year of follow-up was 81%. Notably, zero-fluoroscopy and fluoroscopy-based ablation strategies exhibited comparable freedom from atrial arrhythmias (HR=1.15, 95% CI 0.92-1.43, p=0.2). Similarly, there was no significant difference in the primary outcome when comparing zero-fluoroscopy versus very low fluoroscopy. The complication rate was 1.6% without significant differences between groups (p>0.05). Conclusion Reduced fluoroscopy techniques demonstrated a similar long-term success rate compared to conventional fluoroscopy approaches without increase un complications. These findings endorse recent regulatory agency approvals of tools for performing CA of AF using these strategies.Freedom from atrial arrhythmias Complications