Zero fluoroscopy atrioventricular node ablation and left bundle branch pacing guided by electroanatomic tridimensional mapping system.

Recent publications have reported the feasibility of atrioventricular node ablation (AVNA) and concomitant His-bundle pacing guided by an electroanatomic tridimensional mapping system (ETMS). We report the case of a 65-year-old female patient in which zero fluoroscopy left bundle branch pacing and AVNA were performed guided just by ETMS. Optimal device functioning, electrical parameters stability, and correct lead location were observed 24 h and 30 days after the procedure. In selected cases, in which ionizing radiation is not recommended, this technique may represent an alternative for performing both interventions in the same procedure. <Learning objective: Left bundle branch pacing is a physiological form of ventricular pacing achievable with zero fluoroscopy, being a feasible alternative technique when fluoroscopy is not recommended.>.