Objective To investigate the feasibility and safety of intracardiac echocardiography（ICE） combined with total three-dimensional（T3D） technique in zero-fluoroscopy individualized transseptal puncture. Methods A total of 112 patients with atrial fibrillation who underwent radiofrequency ablation in Yongchuan Hospital Affiliated to Chongqing Medical University from April 2021 to March 2024 were enrolled，and according to the method for transseptal puncture，they were randomly divided into ICE+T3D group with 56 patients and ICE group with 56 patients. The two groups were analyzed in terms of baseline data，time to atrial reconstruction，time to coronary sinus electrode placement，frequency of ICE probe adjustment during transseptal puncture，duration of transseptal puncture，pretreatment time before ablation，incidence rate of complications，and the duration and dosage of X-ray exposure. Results There were no significant differences in baseline data between the two groups. Compared with the ICE group，the ICE+T3D group had a significantly lower frequency of ICE probe adjustment during transseptal puncture（1.70±0.63 vs. 5.34±1.71，P<0.001） and the duration of transseptal puncture（3.66±1.09 min vs. 4.90±1.92 min，P<0.001）. Compared with the ICE group，the ICE+T3D group had significantly longer time to atrial reconstruction（22.44±3.13 min vs. 12.34±2.12 min，P<0.001） and pretreatment time before ablation（49.41±3.52 min vs. 37.65±4.04 min，P<0.001）. In the ICE+T3D group，43（76.8%） patients achieved zero radiation during pretreatment before ablation，and 13 patients received X-ray due to the difficulty in catheter placement； compared with the ICE group，the ICE+T3D group had a significantly shorter duration of X-ray exposure（1.68±0.72 min vs. 3.14±1.95 min，P=0.010） and a significantly lower dosage of X-ray exposure（6.28±2.78 mGy vs. 23.85±21.32 mGy，P=0.004）. During the stage of transseptal puncture，all patients in the ICE+T3D group achieved zero radiation，while 45 patients（80.4%） in the ICE patients received X-ray. In terms of complications，there were no life-threatening complications such as cardiac tamponade，perforation of the aorta by mistake，and embolization in either group，while there was one case（1.8%） of vascular complications in each group. Conclusions ICE combined with T3D after integration and improvement is a safe and reliable procedure for zero-fluoroscopy individualized transseptal puncture.