Background: Three dimensional rotational angiography (3DRA) is a promising newtool for 3D imaging strategy or combined with 3D electroanatomical mapping systemsmight add more understanding to cardiac anatomy in relation to the mapping andablation procedures.Objective: The purpose of this prospective cohort study was to compare the proceduraland clinical outcome of patients with all types of arrhythmia treated by catheterablation using conventional fluoroscopy, three-dimensional (3D) electroanatomicalmapping and/or 3DRA.Methods: From January 2013 to August 2013. Fifty consecutive patients withdifferent types of arrhythmia (mean age 31.8+8.7 years old; 7 patients paroxysmal AF,6 patients with VT, 14 patients with WPW, 21 patients with SVT, 2 patients with WCTwere randomized to ablation using either 3DRA (18 patients), 3D electroanatomicalmapping combined with 3DRA (13 patients) or standard fluoroscopy (19 patients).Results: There was no difference in total radiofrequency applications (56.3+132.8 vs54.8+117.1 minutes, respectively, P: 0.968), procedural duration (130+70 vs 115+73minutes; P: 0.335), fluroroscopic duration (85.2+61.7 vs 71.2+37.7 minutes; P: 0.341),or radiations exposure (71.810+42.954 vs 69.009+38.345 mGy cm2; P: 0.719) betweenprocedures performed with conventional or 3DRA. More significant reduction inmapping time (22.3+13 vs 16.2+8.4, P: 0.056) between conventional vs 3DRA. After amean follow up of 6+2.8 months, there was difference in clinical outcome using eitherconventional or 3DRA concerning total arrhythmia recurrence (19% vs 0%, P: 0.039).Conclusion: Three dimensional rotation angiography guided arrhythmia ablation hassimilar radiation exposure and procedural characteristics, but with much less mappingtime and recurrence rate in comparison to standard fluoroscopic guidance ablation.The ease of use and accurate 3D representation of cardiac chambers make 3DRA areasonable alternative to conventional 3D electroanatomical mapping systems, howeverwithout advanced mapping functions.