Two years after pulmonary vein isolation guided by ablation index—a multicenter study

Background The use of the Ablation Index (AI) software for paroxysmal atrial fibrillation (AF) has been associated with higher acute effectiveness and higher 1‐year arrhythmia freedom. There is, however, a lack of data concerning longer follow‐up. We aim to evaluate the 2‐year outcomes after a standardized AI‐guided pulmonary vein isolation (PVI). Methods Prospective, multicenter study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. PVI was guided by a tailored AI value (≥500 for anterior segment, ≥450 for the roof segments and inferior segments, and 400 for the posterior wall) and an ILD ≤6 mm. The primary endpoints were acute and long‐term effectiveness. Results The study included 218 (842 PV) patients (61% males, median age of 60 [IQR 49–68] years) with paroxysmal AF. First‐pass isolation was obtained in 93% of the patients, with an acute reconnection occurring in 10.6% of the patients (3.2% of the PV) following adenosine trial. After a median follow‐up of 26 (IQR 20–30) months, freedom from any documented atrial arrhythmia was 83.4%, off‐AAD. The rate of adverse events was 1.4%. Although procedural parameters differ across centers ( p < 0.001), the acute ( p = 0.56) and long‐term effectiveness ( p = 0.83) were consistent between centers. Conclusions Patients with paroxysmal AF submitted to an AI‐guided PVI workflow presented high arrhythmia freedom at 2‐years of follow‐up.