Key result
Simultaneous weight-adjusted high-frequency, low-tidal-volume ventilation and rapid atrial pacing reduced total ablation time (67.4 vs 72.4 minutes) compared to standard ventilation.
Why the study?
Data were lacking on a body weight-adjusted high-frequency, low-tidal-volume ventilation strategy combined with rapid atrial pacing during high-power, short-duration AF ablation.
Does simultaneous weight-adjusted high-frequency, low-tidal-volume ventilation and rapid atrial pacing reduce procedural times and improve ablation metrics in patients undergoing de novo high-power, short-duration atrial fibrillation ablation?
Does simultaneous weight-adjusted high-frequency, low-tidal-volume ventilation and rapid atrial pacing reduce procedural times and improve ablation metrics in patients undergoing de novo high-power, short-duration atrial fibrillation ablation?
Absolute Event Rate: 67.4% vs 72.4%
Simultaneous weight-adjusted high-frequency, low-tidal-volume ventilation and rapid atrial pacing reduces procedural times and improves contact force during high-power, short-duration atrial fibrillation ablation.
May optimize CF/CS during AF ablation; leaves open impact on clinical outcomes.
Background: Better contact force (CF) and catheter stability (CS) during atrial fibrillation (AF) ablation are associated with higher success rate. Changes in CF and CS are observed during respiratory movements and cardiac contraction. Previous studies have suggested that rapid atrial pacing (RAP) and high-frequency, low-tidal-volume ventilation (HFLTV) independently or in combination improve CS and CF and quality of lesions. Data from a body weight-adjusted HFLTV strategy associated with RAP in AF high-power, short-duration (HPSD) ablation are still lacking. Objective: This study aimed to compare the results of HPSD AF ablation using simultaneous weight-adjusted HFLTV and RAP and standard ventilation (SV) protocol. Methods: This was a prospective, nonrandomized study with 136 patients undergoing de novo ablation were divided into 2 groups: 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). The ablation used 50 W, CF of 5 to 10 g and 10 to 20 g, and 40 mL/min flow rate on the posterior and anterior left atrial walls, respectively. Results: There were no procedure-related complications. In group A, left atrial and total ablation times were 53.5 ± 8.3 minutes and 67.4 ± 10.1 minutes, respectively. Radiofrequency time was 19.7 ± 5.7 minutes, radioscopy time was 3.4 ± 1.8 minutes, 62 (88.6%) patients had first-pass isolation, 23 (33.3%) patients had elevation of luminal esophageal temperature, and 7 (10%) patients had recurrence. In group B, left atrial time was 56.7 ± 10.8 minutes, total ablation time was 72.4 ± 11.5 minutes, radiofrequency time was 22.4 ± 6.2 minutes, radioscopy time was 3.6 ± 3 minutes, 58 (87.9%) patients had first-pass isolation, and 20 (30.3%) patients had luminal esophageal temperature elevation. Conclusion: retention. The approach produced significantly reduced radiofrequency, left atrial, and total ablation times and better CF and local impedance drop indexes.
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Vassallo et al. (2023) studied Atrial fibrillation (n=136). Rapid atrial pacing (RAP) + high-frequency, low-tidal-volume ventilation (HFLTV) vs. Standard ventilation (SV) in intrinsic sinus rhythm was evaluated on Total ablation time (minutes). Simultaneous weight-adjusted high-frequency, low-tidal-volume ventilation and rapid atrial pacing reduced total ablation time (67.4 vs 72.4 minutes) compared to standard ventilation.
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