To evaluate the feasibility and safety of zero-fluoroscopy radiofrequency catheter ablation guided by the 3D mapping system and intracardiac echocardiography (ICE) compared with traditional fluoroscopy-assisted radiofrequency catheter ablation for the treatment of atrial fibrillation.

This case-control study continuously enrolled patients with atrial fibrillation who underwent radiofrequency ablation at the Department of Cardiology, The First Affiliated Hospital of Soochow University from May 2024 to November 2024. All procedures utilized a 3D mapping system and ICE. Participants were divided into the zero-fluoroscopy group and the low-fluoroscopy group based on intraoperative fluoroscopy usage. Clinical baseline characteristics including age and left atrial anteroposterior diameter, time of each procedure such as time for transseptal puncture and pulmonary vein isolation, intraoperative radiation exposure parameters including fluoroscopy time and radiation dose, and incidence of perioperative complications such as atrioesophageal fistula and cardiac tamponade were compared between the two groups.

This study enrolled a total of 92 cases [70.0% (75/92) males, median age 68.5 (58.0, 73.0) years], with 75 in the zero-fluoroscopy group and 17 in the low-fluoroscopy group. The zero-fluoroscopy group exhibited a younger age compared to the low-fluoroscopy group [67.0 (57.0, 72.0)] years vs. 75.0 (60.5, 78.0) years, P = 0.014], while no statistically significant difference was observed in other baseline clinical characteristics such as age and left atrial anteroposterior diameter(P > 0.05). Compared to the low-fluoroscopy group, the zero-fluoroscopy group demonstrated shorter total procedure time [120.0 (109.0, 131.0) min vs. 135.0 (120.0, 184.5) min, P = 0.019], reduced X-ray exposure duration [0 (0, 0) min vs. 2.0 (1.0, 5.5) min, P < 0.001], and lower X-ray radiation dose [0 (0, 0) mGy vs. 34.0 (4.5, 46.5) mGy, P < 0.001]. Multivariate linear regression analysis demonstrated that the zero-fluoroscopy group was significantly associated with shorter procedure time, reduced fluoroscopy time, and lower radiation dose with adjustment for age as a confounder. No severe perioperative complications occurred in either group.

Zero-fluoroscopy radiofrequency catheter ablation for atrial fibrillation, guided by a 3D mapping system combined with ICE, is safe and feasible.