Projections of future climate suggest increases in extreme temperatures particularly in mid latitudes. In addition, the effect of heat waves, which are becoming a major “summer killer”, is exacerbated in urban areas owing to the heat island effect. Air conditioning (A/C) is a key parameter for health problems in case of heat waves since, on one hand, it reduces mortality but, on the other hand, depending on the heat management, it can increase street temperature therefore increasing the air cooling demand. Results of a meso-scale meteorological model (MESO-NH), coupled to an urban energy balance model including a simplified building model (TEB), are used. Simulations based on a realistic spatial cartography of air-cooled chillers and cooling towers in the city of Paris and surroundings have been performed. The simulation period corresponds to the extreme heat wave in Paris: 9–13 August 2003. Five scenarios will be discussed: firstly a baseline without air-conditioning (NO-AC scenario); secondly the actual situation including individual air dry coolers, wet cooling towers and an urban cooling network relying on free-cooling (water-cooled A/C with the river Seine) (REAL scenario). A third scenario will assume that all the heat is rejected as sensible heat in the atmosphere (DRY AC scenario). Two other scenarios correspond to a prospective where A/C is doubled. Scenario 4 assumes that all the heat is rejected as sensible heat in the atmosphere (DRY ACx2 scenario). On the opposite, scenario 5 assumes that all the heat is rejected underground or in the river Seine (NOREJ scenario). Results show that A/C affects the UHI depending on its management. A detailed analysis on selected districts shows that the local temperature variation resulting from heat island is proportional to the sensible heat rejected locally by A/C, indicating that a clever A/C management is all the more important to provide comfort and to mitigate heat island. Moreover, the incidence of the sky view factor is also discussed.