Background/Objectives: Pulmonary vein isolation (PVI) is the standard treatment for atrial fibrillation (AF), but medium-term success rates remain suboptimal. Non-pulmonary vein triggers, particularly from the superior vena cava (SVC), contribute to AF recurrence. Empirical SVC isolation (SVCi) in addition to standard PVI may improve outcomes. This study evaluated the acute procedural efficacy and safety of PVI with adjunctive SVCi versus PVI alone in patients with paroxysmal AF (PAF). Methods: In this randomized, controlled, single-center study, 149 patients with PAF were assigned to either standard PVI (n = 74) or PVI with adjunctive empirical SVCi (n = 75) using a fourth-generation CB. Primary endpoints were acute procedural success and the incidence of procedure-related complications, particularly phrenic nerve injury (PNI) and sinus node dysfunction. Results: Acute PVI was achieved in all patients; SVCi was successful in 84.9% of the PVI + SVCi group. Major complication rates were low and comparable between groups (0% vs. 2.6%, p = 0.157). However, the overall complication rate was significantly higher in the PVI + SVCi group (50.6% vs. 6.8%, p < 0.001), driven primarily by transient or impending right PNI (38.6% vs. 6.8%, p < 0.001) and sinus node dysfunction. All PNI events resolved before the end of the procedure. Conclusions: Empirical SVCi using a fourth-generation CB is feasible and generally safe, but carries a higher risk of transient PNI and reversible sinus node dysfunction. Therefore, CB SVCi should be approached with caution. Further studies are needed to evaluate long-term outcomes and assess whether the potential benefits outweigh these procedural risks.

Background: Catheter ablation is an established first-line treatment for supraventricular tachycardia (SVT). Traditionally, these procedures have been performed under fluoroscopic guidance. The objective of this study was to demonstrate the feasibility and safety of a completely fluoroless approach, as well as to evaluate clinical outcomes. Methods: This retrospective, single-center analysis included two patient cohorts, comprising a total of 400 patients: 200 in the main (fluoroless) group and 200 in the control (fluoroscopy) group. In the main group, ablation was performed using a 3D mapping system and intracardiac echocardiography (ICE) without the use of fluoroscopy and lead aprons. In the control group, procedures were conducted under fluoroscopic guidance. The primary outcomes were feasibility and safety. Secondary outcomes included acute procedural success, defined as non-inducibility of tachycardia, and chronic success, measured as arrhythmia recurrence-free survival during a 6-month follow-up period. Results: Completely fluoroless ablation was successfully performed in all patients in the main group (100%). Procedures were shorter in the fluoroless group (59.0 ± 25.8 min vs. 72.7 ± 34.0 min, p < 0.001), with no difference in acute success rates (100% vs. 100%). No serious complications occurred in the main group, compared to one event in the control group (0 vs. 1.0, p = 0.313). Arrhythmia recurrence rates during follow-up were similar between groups (HR: 0.877, 95% CI: 0.367–2.097, p = 0.769). Conclusions: A completely fluoroless, “apron-less” approach to SVT ablation is feasible, with complication and success rates comparable to the traditional fluoroscopy-guided approach.