title: Three-dimensional localization versus fluoroscopically only guided ablations: a meta-analysis.
abstract: OBJECTIVE
  Data regarding efficacy and safety of three-dimensional localization systems (3D) are limited. We performed a meta-analysis of randomized trials comparing combined fluoroscopy- and 3D guided to fluoroscopically-only guided procedures.
  
  
  METHODS
  A systematic search was performed using multiple databases between 1990 and 2010. Outcomes were acute and long-term success, ablation, procedure and fluoroscopic times, radiation dose (RD), and complications.
  
  
  RESULTS
  Thirteen studies involving 1292 patients were identified. 3D were tested against fluoroscopic guidance in 666 patients for supraventricular tachycardia (SVT), atrial flutter (AFL), atrial fibrillation (AF), and ventricular tachycardia (VT). Acute and long-term freedom from arrhythmia was not significantly different between 3D and control for AFL (acute success, 97% vs. 93%, p = 0.57; chronic success, 93% vs. 96%, p = 0.90) or for SVT (acute success, 94% vs. 100%, p = 0.36; chronic success, 88% vs. 88%, p = 0.80). A shorter fluoroscopic time was achieved with 3D in AFL (p < 0.001) and in SVT (p = 0.002). RD was significantly less for both AFL (p = 0.002) and SVT (p = 0.01). Ablation and procedure time and complications were not statistically different.
  
  
  CONCLUSIONS
  Success, procedure time, and complications were similar between fluoroscopy- and 3D-guided ablations. Fluoroscopic time and RD were significantly reduced for ablation of AFL and SVT with 3D.
authors: Department of Cardiology, Arrhythmia Services, Schulich Heart Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. Mohammed.Shurrab@sunnybrook.ca
authors: Mohammed
authors: M
authors: Shurrab
authors: Avishag
authors: A
authors: Laish-Farkash
authors: Ilan
authors: I
authors: Lashevsky
authors: Florence
authors: F
authors: Morriello
authors: Sheldon Michael
authors: SM
authors: Singh
authors: Richard John
authors: RJ
authors: Schilling
authors: Harindra Channa
authors: HC
authors: Wijeysundera
authors: Arnold
authors: A
authors: Pinter
authors: David
authors: D
authors: Newman
authors: Eugene
authors: E
authors: Crystal
mesh_terms: D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D016896:Treatment Outcome