Zero-Fluoroscopy Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia Using Intracardiac Electrogram-Guided Mapping with Adjunctive Transthoracic Echocardiography: A Feasibility Case Report from a Resource-Limited Setting

Abstract

Background: Catheter ablation is an established and highly effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT); however, conventional procedures rely on fluoroscopic guidance, exposing patients and healthcare providers to ionizing radiation. In line with the ALARA (As Low as Reasonably Achievable) principle, there is increasing interest in zero- or near-zero fluoroscopy approaches. Case Presentation: We report the case of a 41-year-old male with recurrent symptomatic palpitations diagnosed as typical AVNRT. The patient underwent a completely nonfluoroscopic radiofrequency catheter ablation using intracardiac electrogram-guided mapping with adjunctive transthoracic echocardiography (TTE). The procedure was performed with a confirmed fluoroscopy time of 0 minutes and radiation dose of 0 mGy. TTE provided real-time anatomical orientation, while precise catheter localization and ablation targeting were guided by electrophysiological criteria. Successful slow pathway modification was achieved with a single radiofrequency application, resulting in non-inducibility of tachycardia. Results: The procedure was completed without complications, and the patient remained arrhythmia-free during a one-month follow-up period, as confirmed by Holter monitoring. Conclusion: This case demonstrates that zero-fluoroscopy catheter ablation of AVNRT using intracardiac electrogram-guided mapping with adjunctive TTE is feasible and effective. This approach may represent a practical and accessible alternative in resource-constrained settings where advanced mapping technologies are not readily available. However, further studies are required to establish its safety, reproducibility, and long-term outcomes.