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Multicenter Study
. 2023 Aug;9(8 Pt 2):1543-1554.
doi: 10.1016/j.jacep.2023.05.015. Epub 2023 May 18.

High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study

Jose Osorio  1 , Paul C Zei  2 , Juan C Díaz  3 , Allyson L Varley  4 , Gustavo X Morales  1 , Joshua R Silverstein  5 , Saumil R Oza  6 , Benjamin D'Souza  7 , David Singh  8 , Antonio Moretta  9 , Mark D Metzl  10 , Carolina Hoyos  2 , Carlos D Matos  2 , Estefania Rivera  2 , Anthony Magnano  11 , Tariq Salam  12 , Jose Nazari  10 , Christopher Thorne  4 , Alexandru Costea  13 , Amit Thosani  5 , Anil Rajendra  1 , Jorge E Romero  14
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Free article
Multicenter Study

High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective Study

Jose Osorio et al. JACC Clin Electrophysiol. 2023 Aug.
Free article

Abstract

Background: High-frequency, low-tidal-volume (HFLTV) ventilation is a safe and simple strategy to improve catheter stability and first-pass isolation during pulmonary vein (PV) isolation. However, the impact of this technique on long-term clinical outcomes has not been determined.

Objectives: This study sought to assess acute and long-term outcomes of HFLTV ventilation compared with standard ventilation (SV) during radiofrequency (RF) ablation of paroxysmal atrial fibrillation (PAF).

Methods: In this prospective multicenter registry (REAL-AF), patients undergoing PAF ablation using either HFLTV or SV were included. The primary outcome was freedom from all-atrial arrhythmia at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and hospitalizations at 12 months.

Results: A total of 661 patients were included. Compared with those in the SV group, patients in the HFLTV group had shorter procedural (66 [IQR: 51-88] minutes vs 80 [IQR: 61-110] minutes; P < 0.001), total RF (13.5 [IQR: 10-19] minutes vs 19.9 [IQR: 14.7-26.9] minutes; P < 0.001), and PV RF (11.1 [IQR: 8.8-14] minutes vs 15.3 [IQR: 12.4-20.4] minutes; P < 0.001) times. First-pass PV isolation was higher in the HFLTV group (66.6% vs 63.8%; P = 0.036). At 12 months, 185 of 216 (85.6%) in the HFLTV group were free from all-atrial arrhythmia, compared with 353 of 445 (79.3%) patients in the SV group (P = 0.041). HLTV was associated with a 6.3% absolute reduction in all-atrial arrhythmia recurrence, lower rate of AF-related symptoms (12.5% vs 18.9%; P = 0.046), and hospitalizations (1.4% vs 4.7%; P = 0.043). There was no significant difference in the rate of complications.

Conclusions: HFLTV ventilation during catheter ablation of PAF improved freedom from all-atrial arrhythmia recurrence, AF-related symptoms, and AF-related hospitalizations with shorter procedural times.

Keywords: atrial fibrillation; catheter ablation; first pass isolation; mechanical ventilation; pulmonary vein isolation.

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Conflict of interest statement

Funding Support and Author Disclosures The REAL-AF registry is funded through an investigator-initiated research grant (Dr Osorio, principal investigator) from Biosense Webster. Drs Osorio and Zei have received consulting and research support from Biosense Webster. Dr Silverstein has received consulting and honoraria from Biosense Webster. Drs D’Souza, Metzl, Salam, Rajendra, and Romero have received consulting from Biosense Webster. Dr Thosani reports physician education from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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