Introduction
For nearly a decade, my electrophysiology practice was conducted using a zero-fluoroscopy workflow for radiofrequency (RF) ablation procedures. By relying exclusively on intracardiac echocardiography (ICE) and advanced three-dimensional electroanatomic mapping systems, fluoroscopic imaging was eliminated from routine use. This approach effectively reduced occupational radiation exposure to near zero for all members of the electrophysiology team.
The recent adoption of pulsed field ablation (PFA) technology has been driven by evidence of enhanced procedural efficiency of pulmonary vein isolation. However, currently available commercial PFA platforms, such as the Boston Scientific FaraPulse™ system—reintroduce reliance on fluoroscopy for catheter visualization and manipulation. As a result, operators accustomed to “fluoro-less” workflows have experienced a measurable increase in occupational scatter radiation exposure, particularly to the head, neck, and upper torso. This shift has raised concerns regarding the cumulative long-term effects of repeated low-dose scatter radiation.