Abstract
BACKGROUND: Catheter ablation is the treatment of choice for supraventricular tachycardias. Conventional fluoroscopy (CF) enables real-time guidance but exposes patients and staff to ionizing radiation. Zero- (ZF) or minimal-fluoroscopy (MF) approaches are primarily enabled by electroanatomic mapping, with adjunctive tools such as intracardiac echocardiography used selectively when clinically indicated, to reduce radiation. OBJECTIVE: This study aimed to evaluate the efficacy and safety of ZF/MF ablation compared with CF for supraventricular tachycardias. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials and observational studies comparing ZF/MF with CF ablation. The primary outcomes were acute and long-term success. Long-term success was defined as the absence of arrhythmia recurrence during the follow-up period. RESULTS: 34 studies (5 randomized controlled trials, 29 observational; 11,635 patients) were included. Acute success was similar (risk ratio [RR] 1.00; 95% confidence interval [CI] 0.99-1.01; P = .94), whereas long-term success favored ZF/MF (RR 1.02; 95% CI 1.00-1.03; P = .023). Complications were comparable (RR 0.65; 95% CI 0.26-1.61; P = .35). ZF/MF significantly reduced fluoroscopy time (mean difference [MD] -13.75 minutes; 95% CI -16.49 to -11.02; P < .01) and dose-area product (MD -1511.98 cGy·cm(2); 95% CI -2358.44 to -665.53; P < .01). Procedure duration was slightly longer with ZF/MF (MD +4.47 minutes; 95% CI 0.19-8.75; P = .04). CONCLUSION: ZF/MF ablation provides equivalent acute efficacy, marginal improvement in long-term success, and markedly reduces radiation exposure without increasing complications. These findings support ZF/MF as a safe and effective alternative to CF, with particular relevance for minimizing radiation exposure in vulnerable populations.