not-yet-known not-yet-known not-yet-known unknown Introduction High-power short-duration(HPSD) radiofrequency catheter ablation(RFCA) for atrial fibrillation(AF) has been gradually applied in clinical practice.However,the efficacy and safety of HPSD compared to traditional low-power long-duration (LPLD) ablation are not definitive conclusion. In addition, Zero-fluoroscopy catheter ablation technique has also emerged as a novel method in present ,However research on the combination of zero-fluoroscopy procedure with HPSD catheter ablation for AF are unknown. Objective To evaluate the efficacy and safety of HPSD and LPLD using intracardiac echocardiography (ICE) combined with electroanatomic mapping (EAM) reconstruction for zero-fluoroscopy during RFCA for AF. Methods A total of 173 patients undergoing RFCA for AF were divided into a HPSD(45-50w) group (n=87) and a LPLD (30-35w)group (n=86). The procedure was performed using ICE combined with EAM to achieve zero-fluoroscopy. Both groups underwent routine pulmonary vein isolation(PVI) .There are additional linear ablations for persistent AF at the left atrial roof line, left atrial posterior wall line, mitral isthmus line, and tricuspid isthmus line if necessary. The duration of the procedures, efficacy, short-term and one year successful rates, as well as procedure complications were compared between the two groups. Results The procedure time and ablation time in the HPSD group were significantly shorter than those in the LPLD group(115.8±30.8 vs 130.5±26.3, P =0.001; 14.9±2.3 vs 30.0±4.1, P =.000). There was no difference between the two groups in terms of TSP time(50.0±10.9 vs 51.7±9.0, P =0.273), immediate success rate of PVI(100% vs 100%, P =1.000), single-loop isolation rate of PVI(98.9% vs 95.3%, P =.169), and number of ablation points(71.6±8.4 vs 74.2±14.6, P =.159). At 12 months follow-up, sinus rhythm was maintained in 77 cases in the HPSD group and 74 cases in the LPLD group with no significant difference between them (88.5% vs 86.0%, P =.583). There were 5 and 3 complications in the HPSD group and the LPLD group, respectively, with no difference between the two groups(3.4% vs 5.8%, P =.459). There were no stroke,esophageal atrial fistulae or deaths in either group. Conclusion ICE combined with EAM guidance for zero-fluoroscopy HPSD catheter ablation for atrial fibrillation is safe, reliable and repeatable, and the 1-year success rate is similar to that of traditional power, with a trend of improvement.