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

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.

To evaluate the incidence of hemodynamic or respiratory intolerance of HFJV during PVI.

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.

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.

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.