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Background <p>The efficacy and safety of pulsed-field (PFA) ablation with zero/low-fluoroscopy (ZF/LF) approach is unclear with previous evidence limited to thermal technique.</p> Methods <p>PubMed, Embase, Cochrane Central, were systematically searched for studies reporting outcomes of ZF approach with PFA. Proportions were pooled with a random-effects model using an arcsine transformation to adjust for extreme values.</p> Results <p>14 observational studies were included, comprising a total of 1005 patients who underwent a reduced fluoroscopy pulsed field ablation approach. The pooled acute success rate was 100% (95% CI: 1.0–1.0; I<sup>2</sup> = 0%) with a low arrhythmia recurrence rate in the descriptive analysis. The prevalence of complications was also low. Furthermore, the mean procedure time was 80.9&#xa0;min (95% CI 64.86–97.11; I<sup>2</sup> = 99.4%) and the mean total left atrial dwell time was 46&#xa0;min (95% CI 32.0–61.5; I<sup>2</sup> = 96.9%).</p> Conclusion <p>In this systematic review and meta-analysis, PFA ZF/LF approach demonstrates technical feasibility and favorable safety profile in selected observational studies.</p> Graphical abstract <p></p>

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Zero/Low-fluoroscopy pulsed-field ablation approach: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Gabriel Erzinger,
  • Daniel Teixeira,
  • Matheus S. Ávila,
  • Lívia Castro,
  • Gokul Rajith,
  • Miguel Chaves Lenzi,
  • Vicente Morales Ribeiro,
  • Conrado Roberto Hoffmann Filho,
  • Guilherme Dagostin de Carvalho

摘要

Background

The efficacy and safety of pulsed-field (PFA) ablation with zero/low-fluoroscopy (ZF/LF) approach is unclear with previous evidence limited to thermal technique.

Methods

PubMed, Embase, Cochrane Central, were systematically searched for studies reporting outcomes of ZF approach with PFA. Proportions were pooled with a random-effects model using an arcsine transformation to adjust for extreme values.

Results

14 observational studies were included, comprising a total of 1005 patients who underwent a reduced fluoroscopy pulsed field ablation approach. The pooled acute success rate was 100% (95% CI: 1.0–1.0; I2 = 0%) with a low arrhythmia recurrence rate in the descriptive analysis. The prevalence of complications was also low. Furthermore, the mean procedure time was 80.9 min (95% CI 64.86–97.11; I2 = 99.4%) and the mean total left atrial dwell time was 46 min (95% CI 32.0–61.5; I2 = 96.9%).

Conclusion

In this systematic review and meta-analysis, PFA ZF/LF approach demonstrates technical feasibility and favorable safety profile in selected observational studies.

Graphical abstract