OBJECTIVES: To synthesize the literature evidence comparing Thermocool SmartTouch® Surround Flow (STSF) with SmartTouch (ST) or Surround Flow (SF) radio-frequency catheters for clinical outcomes and efficiency associated with arial fibrillation (AF) ablation.

METHODS: This study searched the mainstay English and Chinese bibliographic databases from 2016 to 2022 for clinical studies directly comparing STSF with ST or SF catheters for AF ablation in adult patients. Meta-analysis with random effects model was used to synthesize the same outcomes reported by two or more studies.

RESULTS: 19 studies comparing STSF with ST catheter and 4 studies comparing STSF with SF for AF ablation were included for evidence synthesis. The pooled evidence indicated that STSF was associated with significantly shorter ablation time [weighted mean difference (WMD): -6.3 minutes, 95% confidence interval (CI) -12.4 to -0.2minutes, p=0.044], shorter fluoroscopy time (WMD: -1.6 minutes, 95% CI -2.8 to -0.3 minutes, p=0.014), and lower total irritation fluid volume (WMD: -492.7 ml, 95% CI -646.1 to -339.3 ml, p<0.001) than ST. The pooled complication profiles between STSF and ST were comparable. In addition, STSF was associated with significantly lower utilizations of Foley catheter [rate ratio (RR): 0.506, 95% CI 0.393 to 0.651, p<0.001] than ST. Relative to SF, STSF was associated with significantly shorter ablation time (WMD: -5.7 minutes, 95% CI -8.4 to -3.1 minutes, p<0.001) and lower risk of one-year arrhythmia recurrence after ablation surgery (RR: 0.503, 95% CI 0.379 to 0.667, p<0.001) than SF.

CONCLUSIONS: Using STSF for AF ablation was superior to using ST by significantly reducing ablation time, fluoroscopy time, and irritation fluid volume during ablation procedure. Compared to SF, STSF significantly reduced ablation time during AF ablation surgery and one-year risk of arrhythmia recurrence after AF ablation.