Difference in hospital readmission among patients with atrial fibrillation undergoing ablation using nonintegrated pulsed field catheter with CARTO™ 3 versus EnSite™ electroanatomical mapping system
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Pulsed field ablation (PFA) is a minimally thermal alternative to traditional thermal catheter ablation for atrial fibrillation (AF), with comparable efficacy and minimal risk of collateral tissue injury. Three-dimensional (3D) electroanatomical mapping systems have been adopted with nonintegrated PFA catheters to improve precision and procedural efficiency. This study compared arrhythmia-related hospital readmissions and procedure-related complications among patients with AF treated with PFA, using either the CARTO™ 3 or EnSite™ electroanatomical mapping system. Materials & methods: Patients who underwent PFA for AF using nonintegrated pulsed field catheters with either CARTO 3 or EnSite were identified from the 2023–2024 Premier Healthcare Database (PHD). The primary outcome was 30-day inpatient readmission and emergency room (ER) visit for AF/atrial flutter (AFL)/atrial tachycardia following the index PFA procedure. Secondary outcomes included 30-day cardiovascular-related readmissions and procedure-related complications. Cohorts were balanced using inverse probability of treatment weighting. Descriptive analyses and a weighted Generalized Estimating Equation (GEE) model were used to assess differences in outcomes between groups. Results: A total of 2894 patients were treated using CARTO 3 and 2015 using EnSite. After weighting, patient and hospital characteristics were well balanced across cohorts. The CARTO 3 group was significantly less likely to experience AF/AFL/atrial tachycardia-related readmissions (0.3% vs 0.9%, chi-square p = 0.023; odds ratio [OR], 0.39; 95% CI, 0.17–0.90, GEE p = 0.028) and a composite outcome of AF/AFL/atrial tachycardia-related inpatient readmission or ER visits (0.5% vs 1.1%, chi-square p = 0.020; OR: 0.44, 95% CI: 0.21–0.89, GEE p = 0.023) within 30 days of PFA procedure than the EnSite group. No differences were observed in cardiovascular-related readmission or complications. Conclusion: In this retrospective, real-world study, patients with AF who underwent PFA using CARTO 3 had lower 30-day AF/AFL/atrial tachycardia-related readmissions rates than those treated with EnSite suggesting that choice of mapping system may influence early AF outcomes and could translate into reduced downstream hospitalizations and resource use.
Plain language summary
What is this article about?
Atrial fibrillation (AF) is a common heart rhythm disorder that can be treated with a procedure called pulsed field ablation (PFA), which uses electrical pulses to target and destroy heart muscle cells responsible for the abnormal rhythm. During the procedure, electroanatomical mapping systems help guide the treatment by creating a detailed map of the heart. This study compared hospital readmission rates and complications after PFA procedures performed using two different electroanatomical mapping systems: CARTO™ 3 and EnSite™.
What were the results?
This study analyzed the data of 4909 patients with AF treated with PFA in 2023–2024. Patients treated using the CARTO 3 system were 56% less likely to be readmitted to the hospital or emergency room within 30 days for AF, atrial flutter, or atrial tachycardia compared with those treated using the EnSite system. Both groups had similar rates of cardiovascular-related hospital readmissions and procedure-related complications.
What do the results mean?
These findings suggest that the choice of mapping system used to guide PFA may influence early heart rhythm-related hospital readmissions. The CARTO 3 system may offer an advantage in preventing recurrence of arrhythmia after the procedure.
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© 2026 The authors. This work is licensed under the Creative Commons Attribution 4.0 License
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Received: 19 September 2025
Accepted: 4 December 2025
Published online: 8 January 2026
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Difference in hospital readmission among patients with atrial fibrillation undergoing ablation using nonintegrated pulsed field catheter with CARTO™ 3 versus EnSite™ electroanatomical mapping system. (2026) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2025-0151
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