Comparison between weight-adjusted, high-frequency, low-tidal-volume ventilation and atrial pacing with normal ventilation in high-power, short-duration atrial fibrillation ablation: Results of a pilot study

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: Weight-adjusted HFLTV with RAP in comparison with SV and intrinsic sinus rhythm in HPSD ablation is safe with no CO(2) retention. The approach produced significantly reduced radiofrequency, left atrial, and total ablation times and better CF and local impedance drop indexes.