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While radiation exposure related to natural sources plays a minor role, medicine-related exposure, represents, to date, a major exposure source. Within this exposure interventional electrophysiology is a relevant contributor. Unfortunately, no safe dose in radioprotection exists, the negative acute and long-term effects of radiological exposure may emerge at any radiation exposure dose. For this reason, patients and physicians should be aware of the risk of radiation exposure and the benefits of the imaging/procedure balanced by the required radiation exposure. Given this, performing a near to zero X-rays transcatheter ablation procedure should therefore represent an aim for all electrophysiological lab. Fortunately, the introduction of electroanatomic mapping systems, have provided the possibility to perform simple and complex electrophysiological procedures avoiding, or at least, limiting the use of radiations. The present review summarizes state of the art of feasibility and safety of the near to zero approach for the main electrophysiological procedures, highlighting the potential health benefits.