Comparison of Integrated 3D Electroanatomic Mapping and Conventional Mapping Systems for Pentaspline Pulsed Field Ablation of Atrial Fibrillation

INTRODUCTION: Pulsed field ablation (PFA) is an established therapy for atrial fibrillation (AF), yet optimal mapping strategies during pentaspline PFA remain uncertain. We compared procedural characteristics and material costs of an integrated 3D electroanatomic mapping (EAM) platform with conventional mapping systems. METHODS AND RESULTS: In a multicenter observational study of 448 consecutive AF ablations done using pentaspline catheter (62 integrated mapping; 386 conventional mapping) performed between February 2024 and August 2025, baseline characteristics were similar between groups. Compared with conventional mapping, the integrated platform was associated with shorter total procedure time (49 ± 16 vs. 66 ± 26 min, p < 0.001), shorter left atrial dwell time (35 ± 12 vs. 46 ± 30 min, p < 0.001), reduced fluoroscopy time (6 ± 4 vs. 12 ± 7 min, p < 0.001), lower radiation dose (36 ± 10 vs. 93 ± 18 mGy, p < 0.001), and lower mean material cost ($12 958 ± 164 vs. $14 739 ± 1192, p < 0.001). Differences were consistent across lesion sets. Acute pulmonary vein isolation was achieved in all patients, with two major complications occurring in the conventional mapping group. CONCLUSION: Integrated 3D EAM during pentaspline PFA was associated with shorter procedures, lower radiation exposure, and reduced material costs. These findings support the procedural and operational advantages of integrated mapping platforms in contemporary AF ablation practice.