Comparative evaluation of zero-fluoroscopy and conventional fluoroscopy approaches in catheter ablation of premature ventricular contractions: a single-center experience

Background Catheter ablation of premature ventricular contractions (PVCs) is an effective treatment modality, but traditionally involves fluoroscopy, which poses radiation risks. Recently, zero-fluoroscopy (ZF) techniques have emerged as a safer alternative, especially in young patients and those requiring multiple procedures. Methods This retrospective, single-center study evaluated 150 patients who underwent PVC ablation between January 2023 and March 2025. Patients were divided into two groups: those treated with ZF (n=75) and conventional fluoroscopy (CF) (n=75). Procedural characteristics, procedure time, success rates and complications were compared. Results Acute procedural success was achieved in 79.3% overall, with comparable rates between ZF and CF groups (78.7% vs 80.0%, p = 0.84). The median procedure time was similar (88 min vs 90 min, p = 0.14), and no significant differences were observed in complication rates (4.0% vs 4.0%, p = 1.00). Stratified analysis revealed longer procedure times in anatomically complex PVC origins, particularly in LV-superior and summit regions (p < 0.001), whereas RV-inferior PVCs showed the highest success (90%) and shortest duration (p < 0.05). Univariate logistic regression identified higher PVC burden and longer procedure time as predictors of procedural failure. No coronary or atrioventricular conduction injury occurred in either group. Conclusion Zero-fluoroscopy PVC ablation is a safe and effective alternative to conventional methods. Despite longer durations in anatomically complex cases, the ZF approach avoids radiation without compromising outcomes.