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 pulmonary vein isolation.
Methods: We retrospectively followed 123 consecutive patients who underwent AI-guided
CA shortly after its introduction to routine practice. Data were collected from the
MPH AF Ablation Registry with the approval of the institutional research board. Results:
Our patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger
left atrial sizes compared to similar previously published cohorts, while gender balance
and other characteristics were similar. The probability of freedom from atrial arrhythmia
with repeat procedures is 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 years (p = 0.02, HR: 2.7, CI: 1.14-6.7), BMI >35
kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8-11.4), and left atrial 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 1 year and
72.3% at 5 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. [Graphical Abstract]
