Introduction <p>Pulsed field ablation (PFA) as an energy source has caused a paradigm shift in how atrial fibrillation ablation is performed with regards to safety, efficiency, and patient experience. Initial studies throughout the United States and Europe demonstrated excellent procedural safety and efficacy but embraced fluoroscopy as a cornerstone of procedural workflow. In this manuscript, we report the one-year safety and efficacy outcomes of a fluoroless workflow in a case–control design.</p> Methods <p>100 consecutive subjects underwent PFA atrial fibrillation ablation with a pentaspline catheter, Intracardiac Echo (ICE) and 3D anatomic mapping but without fluoroscopy. All procedures were performed at a single center, and subjects were enrolled retrospectively. A historical cohort of 100 subjects that underwent Radiofrequency ablation (RF) of atrial fibrillation was used for comparison.</p> Results <p>Over the study period, a total of 100 subjects (63&#xa0;M/37F); age 67 ± 9.9 underwent PF ablation and were compared with historical control group of subjects that underwent RF ablation. The average CHA₂DS₂-VASc score was 2.8 (± 1.7). The average LVEF was 59.6% (± 8.8). An average of 45.8 (± 17.7) total PF ablation lesions were delivered. Acute isolation was achieved in all subjects. Longitudinal freedom from atrial fibrillation did not differ between the RF and PF arm at three months (89% vs 93%, <i>p</i> = 0.34), six months (84% vs 89%, <i>p</i> = 0.32) or 12&#xa0;months (79% vs 85%, <i>p</i> = 0.31).</p> Summary <p>Fluoroless PFA for atrial fibrillation with a pentaspline catheter can be done safely and effectively, with excellent long term outcomes using ICE and 3-D mapping. In addition, the one year freedom from atrial fibrillation using a fluoroless strategy with PFA is at least equivalent to RF. Operators should consider adopting a fluoroless workflow for PFA for the benefit of staff and patients.</p> Graphical Abstract <p></p>