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 fibril-lation (AF) has been associated with higher acute effectiveness and higher 1-year ar -rhythmia 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 parox-ysmal 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 pa-tients, 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, free-dom 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