AUTHOR=Fitzpatrick N. , Herczeg S. , Hong K. , Seaver F. , Rosalejos L. , Boles U. , Jauvert G. , Keelan E. , O’Brien J. , Tahin T. , Galvin J. , Széplaki G. 

TITLE=Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1332868

DOI=10.3389/fcvm.2023.1332868

ISSN=2297-055X

ABSTRACT=Background: Catheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence, hence there is scope to potentially improve outcomes through technical innovations such as Ablation Index (AI) guidance during AF ablation. We present real world 5-year follow-up data of AI guided PVI. Methods: We retrospectively followed 123 consecutive patients who underwent AI guided CA shortly after its introduction to routine practice. Data was collected via the MPH AF Ablation Registry with institutional research board approval.Results: Our patient cohort were older, with higher BMI, greater CHA2DS2-VASc scores and larger left atrial sizes when compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures was as follows: Year 1: 0.95, Year 2: 0.92, Year 3: 0.85, Year 4: 0.79 and Year 5: 0.72. Age > 75 (p=0.02 HR 2.7 CI 1.14-6.7), ) and LA width as measured on CT in the upper quartile (p=0.04 HR 2.5 CI 1-5.7) were statistically significant independent predictors of recurrent AF.Conclusion: AI guided CA is an effective treatment for AF with 95.8% of patients remaining free from atrial arrhythmia at one year and 72.3% at five years allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age > 75 years, BMI > 35 kg/m2 and markedly enlarged atria were associated with higher recurrence rates.