BACKGROUND A zero-fluoroscopy approach guided by a 3-dimensional navigation system is an alternative to the traditional conventional fluoroscopy-navigation approach for ablation of tachycardia. AIMS To compare the safety and efficacy of zero-fluoroscopy ablation of supraventricular tachycardia (SVT) guided by the CARTO mapping system (CZF) alone, the EnSite zero-fluoroscopy mapping system (EZF) alone, or the conventional fluoroscopy (CF) ablation method. METHODS From July 2015 to March 2017, patients admitted for SVT ablation were prospectively and consecutively enrolled in the CF, EZF, and CZF groups in a 1:1:1 ratio. The procedures for the CF group were performed using the traditional fluoroscopy method or the 3-dimensional mapping method. All data were prospectively recorded by independent researchers. Procedure and fluoroscopic time as well as rate of success, recurrence, and complications in the 3 groups were analyzed. RESULTS One patient from the CZF group was moved to the CF group due to a severe venous malformation during catheter insertion. A total of 100 patients (100%) in the CF group, 100 patients (100%) in the EZF group (100%), and 99 patients (99%) in the CZF group successfully completed the electrophysiology study. There were no severe complications in any of the groups. The mean (SD) procedure time was 61.8 (36.2), 66.5 (24.2), and 65.4 (27.5) minutes in the CF, EZF, and CZF group, respectively. The median (interquartile range) fluoroscopy time of the CF group was 3.6 (2.1-8.8) minutes. CONCLUSIONS The zero-fluoroscopy approach guided by the CARTO system is not inferior to the zero-fluoroscopy approach guided by the EnSite system or a conventional fluoroscopic approach in terms of the efficiency and safety for ablation of SVT.