Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Safety and efficacy of intracardiac echocardiography-guided zero-fluoroscopic cryoballoon ablation for atrial fibrillation: a prospective randomized controlled trial.
Trial report in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Intracardiac Echocardiography during Invasive Electrophysiological Procedures: a Scientific Statement of the European Heart Rhythm Association of the ESC, and the European Association of Percutaneous Cardiovascular Interventions of the ESC.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Guideline
- Safety and efficacy of the pulsed field ablation for persistent atrial fibrillation: a meta-analysis.BMC cardiovascular disorders · 2026Pooled it
- Safety and efficacy of intracardiac echocardiography in atrial fibrillation ablation: a meta-analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Pooled it
- Meta-analysis of the safety and efficacy between pulsed field ablation vs. traditional ablation for persistent atrial fibrillation.Frontiers in cardiovascular medicine · 2026Pooled it
- Intra-Procedural Three-Dimensional Rotational Angiography in Cryoballoon Ablation of Atrial Fibrillation: An RCT.Pacing and clinical electrophysiology : PACE · 2026Trial
- Molecular Basis of Adipose-Cardiac Crosstalk in Cardiovascular Diseases: From Mechanisms to Therapeutic Opportunities.Biomolecules · 2026Review
- Transseptal puncture in cardiovascular interventions: a clinical consensus statement of the European Heart Rhythm Association, the Heart Failure Association, the European Association of Percutaneous Cardiovascular Interventions, the European Association of Cardiovascular Imaging of the ESC, and the Association for European Paediatric and Congenital Cardiology.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Atrial fibrillation ablation using three-dimensional artificial intelligence module integration with intracardiac echocardiography.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Left Atrial Intracardiac Echocardiography to Assist Zero Fluoroscopy Pulse Field Atrial Fibrillation Ablation-A Beginner's Guide.CJC open · 2026Article
- Multicenter Practice of Non/Minimized Fluoroscopy Ablation for Paroxysmal AF in China: The PAF-ICE Trial.JACC. Asia · 2025Article
- Paving the Way to a Radiation-Free Era: Generalizability of Nonminimized/Minimized Fluoroscopy Atrial Fibrillation Ablation.JACC. Asia · 2025Article
- Acute outcomes of cryoballoon vs. circular vs. pentaspline pulsed-field ablation catheters in combined pulmonary vein isolation and roof line ablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Article
- A Fluoroscopy-Free Ablation Workflow for Persistent Atrial Fibrillation Using a Pentaspline Pulse Field Ablation Catheter Guided by Left-Sided Intracardiac Echo Imaging and Electroanatomic Mapping: A Case Series.Journal of cardiovascular development and disease · 2025Article
- An Antiquated Concept in the Novel Era of Ablation: Zero-fluoroscopy Pulsed Field Ablation for Treatment of Atrial Fibrillation.The Journal of innovations in cardiac rhythm management · 2025Article
- Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation.Journal of clinical medicine · 2025Article
- A practical guide and review of the literature on zero-fluoroscopy electrophysiology catheter navigation by intracardiac echocardiography.The international journal of cardiovascular imaging · 2025Review
- Feasibility and safety of zero-fluoro, "apron-less" approach to repeat pulmonary vein isolation procedures using radiofrequency energy after initial cryoballoon ablation.Scientific reports · 2025Article
- Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis.Biomedicines · 2025Review
- Evaluation of the novel multi-points surface thermometry cryoballoon in the treatment of paroxysmal atrial fibrillation.Frontiers in cardiovascular medicine · 2025Article
- The impact of peri-procedural imaging on safety and efficacy of atrial fibrillation ablation: insights from the Israeli AF Catheter Ablation Registry (ICAR).Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
aimsThe development of intracardiac echocardiography (ICE) has enabled fluoroless atrial fibrillation (AF) ablation using three-dimensional electroanatomical mapping systems. However, fluoroless cryoballoon ablation (CBA) remains challenging, mainly because of the lack of a visual mapping system. Hence, this study aimed to investigate the safety and efficacy of fluoroless CBA for AF under ICE guidance. METHODS AND
resultsPatients (n = 100) who underwent CBA for paroxysmal AF were randomly assigned to zero-fluoroscopic (Zero-X) and conventional groups. Intracardiac echocardiography was used to guide the transseptal puncture and catheter and balloon manipulation in all enrolled patients. The patients were prospectively followed for 12 months after CBA. The mean age was 60.4 years, and the left atrial (LA) size was 39.4 mm. Pulmonary vein isolation (PVI) was achieved in all patients. In the Zero-X group, fluoroscopy was used in only one patient because of unstable phrenic nerve capture during right-sided PVI. The procedure time and LA indwelling time in the Zero-X group were not statistically different compared with that in the conventional group. Fluoroscopic time (9.0 vs. 0.008 min) and radiation exposure (29.4 vs. 0.02 mGy) were significantly shorter in the Zero-X group than in the conventional group (P < 0.001). The complication rate did not differ between the two groups. During a mean follow-up of 663.3 ± 172.3 days, the recurrence rate was similar (16.0 vs. 18.0%; P = 0.841) between the groups. Multivariate analysis revealed that LA size was the only independent predictor of clinical recurrence.
conclusionIntracardiac echocardiography-guided fluoroless CBA for AF was a feasible strategy without compromising acute and long-term success or complication rates.
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