High-Frequency Low-Tidal Volume Ventilation and Procedural Efficiency in Atrial Fibrillation Catheter Ablation: A Single-Center Retrospective Study

OBJECTIVES To compare high-frequency low-tidal volume (HFLTV) ventilation with standard ventilation (SV) regarding procedural efficiency, airway mechanics, and clinical outcomes in atrial fibrillation (AF) catheter ablation. DESIGN Retrospective, observational, nonrandomized cohort study. SETTING Electrophysiology laboratory of a single tertiary-care university hospital. PARTICIPANTS There were 160 consecutive eligible adults undergoing first-time AF radiofrequency ablation under general anesthesia between June 2023 and May 2024. INTERVENTIONS Patients received HFLTV (n = 80; respiratory rate 25-30 breaths/min, tidal volume 3-4 mL/kg, ETCO₂ maintained <50 mmHg) or SV (n = 80; tidal volume 6-8 mL/kg, respiratory rate 10-12 breaths/min) per attending anesthesiologist practice. All received propofol-remifentanil total intravenous anesthesia. MEASUREMENTS AND MAIN RESULTS Primary outcomes were total procedure time and radiofrequency ablation time; secondary outcomes were airway pressures, oxygenation, AF recurrence at 1 and 6 months, AF-related hospitalization, and complications. HFLTV was associated with lower median procedure time (110 v 128 minutes; p < .001) and ablation time (23 v 28 minutes; p < .001). Peak (14 v 18 cmH₂O) and minimum (13 v 15 cmH₂O) airway pressures were lower with HFLTV (both p < .001), whereas ETCO₂ and SpO₂ nadir were comparable. Multivariable regression identified HFLTV as an independent predictor of shorter ablation time (nonstandardized β=-5.48 minutes; 95% CI -7.05 to -3.91; p < .001). In exploratory analyses, recurrence at 1 month (7.5% v 15.0%; p = .211) and 6 months (13.8% v 18.8%; p = .520) and 6-month AF-related hospitalization (12.5% v 18.8%; p = .384) were numerically lower with HFLTV but confidence intervals were wide and included no difference. CONCLUSION In a consecutive cohort including paroxysmal and persistent AF, HFLTV was associated with shorter procedure and ablation times and lower measured airway pressures without compromising gas exchange. Clinical outcome analyses were exploratory and hypothesis-generating, warranting prospective randomized evaluation.