Procedural and Clinical Outcomes of High-Frequency-Low-Tidal-Volume Ventilation Plus Rapid-Atrial Pacing in Paroxysmal Atrial Fibrillation Ablation

Background High-frequency low-tidal volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation (PAF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined. Objective To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of PAF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone. Methods Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of PAF using either HFLTV+RAP or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-months. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and complications. Results A total of 545 patients were included (HFLTV+RAP=327 vs. HFLTV=218). There were no significant differences in baseline characteristics. No differences in procedural (HFLTV+RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p=0.617) and RF (HFLTV+RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p=0.620) times. Both groups had a similar freedom from all-atrial arrhythmias at 12 months (HFLTV+RAP 82.68% vs. HFLTV 86.52%, HR=1.43, 95% CI [0.94-2.16], p=0.093). There were no differences in freedom from AF-related symptoms (HFLTV+RAP 91.4% vs. HFLTV 93.1%, p=0.476) and rate of AF-related hospitalizations (HFLTV+RAP 1.5% vs. HFLTV 2.8%, p=0.320) between groups. Procedure-related complications were low in both groups (HFLTV+RAP 0.6% vs. HFLTV 0%, p=0.247). Conclusion In patients undergoing RFCA for PAF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes. Condensed Abstract High-frequency low-tidal volume (HFLTV) ventilation is a safe and cost-effective strategy that improves the efficiency and efficacy of radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF). Our study aimed to assess the effect of HFLTV-ventilation plus rapid-atrial pacing (RAP) during RFCA of PAF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone. Patients from the REAL-AF registry who underwent PAF-RFCA from April 2020-February 2023, using HFLTV-ventilation alone or in combination with RAP, were analyzed. Our study concluded that in patients undergoing RFCA for PAF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.