Zero‐Fluoroscopy Versus Conventional Catheter Ablation for Premature Ventricular Contractions

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 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 a higher PVC burden and a 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.