Zero‐Fluoroscopy High‐Power Short‐Duration Ablation in Atrial Fibrillation: Safety, Efficacy, and Feasibility Comparison

INTRODUCTION: Atrial fibrillation (AF) is a common cardiac arrhythmia with significant morbidity. Catheter ablation is effective, but traditional fluoroscopic guidance carries radiation risks. This study compares zero-fluoroscopy (ZF) with high-power short-duration (HPSD) ablation to conventional strategies in patients with symptomatic non-valvular paroxysmal AF undergoing pulmonary vein isolation (PVI). METHODS: A retrospective analysis of 312 PVI patients was conducted, divided into three groups: control (fluoroscopy and conventional power), HPSD, and ZF combined with HPSD (ZF + HPSD). Outcomes measured were procedural success, safety, efficacy at 1-year follow-up, and complications. RESULTS: All groups achieved 100% PVI with similar first-pass isolation rates. The ZF + HPSD group had no fluoroscopic time or radiation exposure and reduced septal puncture and left atrial (LA) mapping times compared to controls. Ablation and procedural times were shorter for HPSD and ZF + HPSD groups. One-year freedom from atrial arrhythmia rates were not significantly different (Control: 78.8%; HPSD: 82.7%; ZF + HPSD: 85.6%; p = 0.205). No major complications were observed during follow-up. LA diameter predicted AF recurrence. CONCLUSION: The ZF + HPSD approach for AF ablation is feasible, safe, and effective, offering reduced radiation exposure. It was non-inferior to HPSD in safety and efficacy at 1-year follow-up, suggesting broader clinical application potential.