Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta-analysis.

Introduction: Catheter placement and stability are well-known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter-tissue contact. The purpose of this systematic review and meta-analysis is to see if employing a SS influences procedure outcome.

Method: We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow-up. The secondary outcomes were the procedure-related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model.

Results: A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09-1.29;  < .001). Both techniques had similar rate for procedural-related complication (RR: 1.09, 95% CI 0.50-2.39;  = .83). The SS strategy had a shorter procedure time (MD -10.6 [min], 95% CI -20.97, -0.20;  = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group.

Conclusions: The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.