Completely Fluoroless, “Apron-Less” Approach to Supraventricular Tachycardia Ablation Compared to Traditional Fluoroscopy Guided Ablation: Feasibility, Safety and Clinical Outcomes

<b>Background:</b> Catheter ablation is an established first-line treatment for supraventricular tachycardia (SVT). Traditionally, these procedures have been performed under fluoroscopic guidance. The objective of this study was to demonstrate the feasibility and safety of a completely fluoroless approach, as well as to evaluate clinical outcomes. <b>Methods:</b> This retrospective, single-center analysis included two patient cohorts, comprising a total of 400 patients: 200 in the main (fluoroless) group and 200 in the control (fluoroscopy) group. In the main group, ablation was performed using a 3D mapping system and intracardiac echocardiography (ICE) without the use of fluoroscopy and lead aprons. In the control group, procedures were conducted under fluoroscopic guidance. The primary outcomes were feasibility and safety. Secondary outcomes included acute procedural success, defined as non-inducibility of tachycardia, and chronic success, measured as arrhythmia recurrence-free survival during a 6-month follow-up period. <b>Results:</b> Completely fluoroless ablation was successfully performed in all patients in the main group (100%). Procedures were shorter in the fluoroless group (59.0 ± 25.8 min vs. 72.7 ± 34.0 min, <i>p</i> < 0.001), with no difference in acute success rates (100% vs. 100%). No serious complications occurred in the main group, compared to one event in the control group (0 vs. 1.0, <i>p</i> = 0.313). Arrhythmia recurrence rates during follow-up were similar between groups (HR: 0.877, 95% CI: 0.367-2.097, <i>p</i> = 0.769). <b>Conclusions:</b> A completely fluoroless, "apron-less" approach to SVT ablation is feasible, with complication and success rates comparable to the traditional fluoroscopy-guided approach.