Navigating the Zero Fluoroscopy Frontier: Current Tools, Evidence and Future Directions in Electrophysiology Procedures

Fluoroscopy has traditionally been the mainstay imaging technique for guidance during electrophysiology (EP) ablation procedures. The numerous disadvantages associated with radiation exposure for both operators and patients have created the need for zero-fluoroscopy (ZF) approaches. Today, electrophysiologists have access to a wide range of ZF tools, including electroanatomic mapping systems, transoesophageal and intracardiac echocardiography, visualisable sheaths, contact-force sensing catheters, preprocedural advanced cardiac imaging integration, and real-time cardiac magnetic resonance EP guidance. An increasing body of evidence supports the adoption of ZF protocols in managing of the full spectrum of arrhythmias, with feasibility demonstrated without compromise to efficacy or safety. The future of ZF appears highly promising, driven not only by continued refinement of the existing systems but also by the seamless convergence of emerging technologies.