A Standardized Zero‐Fluoroscopy, 3D‐Guided Workflow for AVNRT Ablation With Same‐Day Discharge: PICENO AVNRT Approach

INTRODUCTION: Slow-pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) is highly effective but carries a small risk of atrioventricular block. A fully standardized, safety-driven 3D-guided workflow tailored to AVNRT ablation has not been clearly defined. METHODS AND RESULTS: We retrospectively analyzed 150 consecutive day-hospital patients with invasive electrophysiological confirmation of AVNRT who underwent ablation using the standardized PICENO AVNRT approach between 2017 and 2025. The protocol integrates Koch's triangle pace mapping and voltage-bridge mapping to guide slow-pathway ablation. Acute success was achieved in 100% of patients. No transient or permanent AV block occurred. Fluoroscopy was not required in any case. Mean procedure time was 62 ± 14 min. At 30.5 ± 18.8 months of follow-up, one recurrence (0.7%) was observed. CONCLUSION: A standardized 3D-guided safety-driven workflow for AVNRT ablation is feasible and reproducible in a day-hospital setting, achieving excellent outcomes while eliminating fluoroscopy because of procedural reliability.