Zero-Fluoroscopy Versus Conventional Catheter Ablation for Premature Ventricular Contractions

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.

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.

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.

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.