Hemodynamic intolerance and pericardial effusion associated with high-frequency jet ventilation during pulmonary vein isolation

BACKGROUND: High-frequency jet ventilation (HFJV) is used during pulmonary vein isolation (PVI) to increase catheter stability and improve outcomes. In prior studies, hemodynamic intolerance to HFJV was rare. OBJECTIVES: To evaluate the incidence of hemodynamic or respiratory intolerance of HFJV during PVI. METHODS: Retrospective observational analysis of consecutive patients undergoing PVI performed by 2 operators (PT, JW) at our institution between February 2019 and June 2020 who developed persistent hypotension or abnormal ventilatory parameters in association with HFJV. RESULTS: Among 194 PVIs, there were 8 cases (4%) of conversion from HFJV to conventional ventilation, 6 for refractory hypotension and 2 for persistently abnormal gas exchange. In 6 patients, including 5 of the 6 patients with refractory hypotension, a new, small pericardial effusion without tamponade was noted just after HFJV was initiated. In patients with persistent hypotension, a decrease in left ventricular filling and systolic function was frequently noted. Both the hemodynamic changes and effusion resolved almost immediately after discontinuation of HFJV. In 4 patients rechallenged with HFJV, the hypotension and/or effusion recurred quickly and again resolved immediately after return to conventional ventilation. CONCLUSION: HFJV-associated hypotension and systolic dysfunction, often accompanied by a transient pericardial effusion, is present in a small proportion of patients undergoing PVI, and resolves with cessation of HFJV. The mechanism of these changes is unclear and warrants further study.