Ablation Index-Guided Radiofrequency Ablation for Atrial Fibrillation: An Updated Meta-Analysis on Its Procedural Efficacy and Safety Profiles

Atrial fibrillation (AF) is the most common sustained arrhythmia, with radiofrequency ablation (RFA) being a key treatment strategy. Despite its success, AF recurrence postablation is significant, and the ablation index (AI) was introduced to improve lesion quality and clinical outcomes. The aim of this study was to provide updated safety and efficacy data regarding AI-guided ablation strategy. A systematic literature review was performed utilizing the PubMed, Embase, Cochrane, and Web-of-Science databases to retrieve double-arm retrospective and prospective studies comparing AI-guided ablation to non-AI guided ablation from inception until January-2024. The initial literature search yielded 700 studies, with 18 double-arm full articles included in the analysis after screening and exclusions. The cohort consisted of 2030 patients undergoing AI-guided ablation and 1580 undergoing non-AI-guided ablation. The average age of the cohort was 64.09 ± 9.86 years, with a median follow-up period of 12 months. AI-guided ablation was associated with lower AF recurrence (22% vs 32%, OR = 0.67, 95% CI = 0.59–0.77, p < 0.001). It also resulted in shorter total procedure time (145 min vs 159 min, SMD = -0.47, 95% CI = −0.78–-0.16, p = 0.005) and fluoroscopy time (8.8 min vs 11.3 min, SMD = −0.35, 95% CI = -0.55 to -0.20, p < 0.001). No significant difference was observed in ablation time. First pass isolation was more likely with AI-guided ablation (80% vs 60%, OR = 1.44, 95% CI = 1.04–2.01, p = 0.037). Complication rates were similar between groups (OR = 0.79, 95% CI = 0.47–1.32, p = 0.33). In conclusion, AI-guided ablation significantly reduces AF recurrence and procedure times compared to non-AI-guided methods, without increasing complication rates, indicating its efficacy and safety in clinical practice.