Do we still need X-rays to ablate atrial fibrillation? A novel zero-fluoroscopy workflow

In atrial fibrillation (AF) procedures, fluoroscopy remains the main technology used to guide the transseptal puncture. We present a workflow to perform a zero-fluoroscopy ablation procedure of both paroxysmal and persistent AF using a 3D electro anatomical mapping (EAM) system, intracardiac echocardiography (ICE) and a novel steerable guiding sheath that can be visualized on the mapping system. We present two case reports during which we applied this novel workflow achieving a successful pulmonary vein isolation without complications and zero-fluoroscopy exposure.