Background: Prior studies have shown that a standardized pulmonary vein isolation (PVI) workflow guided by a single ablation index (AI) value and a maximum interlesion distance (ILD) between corresponding ablation tags is associated with high single-procedure 1-year clinical success. Improvement in 1-year success may translate to lower cardiovascular healthcare utilization.
Purpose: To evaluate the effect of a standardized AI workflow in PAF ablation on cardiovascular healthcare utilization.
Methods: Patients were ablated for PAF in a prospective non-randomized clinical study across 17 European centres. Ablations followed a standard AI workflow (AI targets: 400 posterior, 550 anterior, ILD ≤6 mm) utilizing a contact force catheter, location stability settings of 2-3 mm for 3-5 s, 3 g force, and 25% force over time. Cardioversions and overnight cardiovascular hospitalizations were recorded for the 12-month periods pre- and post-ablation.
Results: A total of 329 patients were eligible and ablated with AI guidance (age 61 ± 10 years, 60.8% male, CHA2DS2-VASc 1.6 ± 1.4). Cardiovascular hospitalizations were reduced by 42% (99 to 57, p=0.0015) and cardioversions were reduced by 62% (77 to 29, p<0.0001) after ablation (Figure). The 57 post-ablation cardiovascular hospitalizations included 35 repeat ablations in 33 subjects (10%).
Conclusion: A standardized workflow incorporating AI guidance with a maximum ILD for PAF ablation resulted in a substantial reduction in cardiovascular hospitalization in the 12 months following ablation compared to the 12 months prior.