High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Outcomes in AF Ablation: A Multicenter Prospective...

Area of Science:

• Cardiology
• Medical Devices
• Respiratory Therapy

Background:

• High-frequency, low-tidal-volume (HFLTV) ventilation is recognized for enhancing catheter stability and first-pass isolation during pulmonary vein (PV) isolation.
• However, its long-term clinical impact following radiofrequency (RF) ablation for paroxysmal atrial fibrillation (PAF) remains under investigation.

Purpose of the Study:

• To evaluate the acute and long-term efficacy of HFLTV ventilation versus standard ventilation (SV) in patients undergoing RF ablation for PAF.
• To compare procedural characteristics, arrhythmia recurrence, symptom burden, and hospitalization rates between the two ventilation strategies.

Main Methods:

• A prospective multicenter registry (REAL-AF) enrolled 661 patients undergoing PAF ablation.
• Patients were assigned to either HFLTV or SV groups.
• The primary endpoint was freedom from all-atrial arrhythmia at 12 months, with secondary outcomes including procedural metrics and clinical events.

Main Results:

• HFLTV ventilation was associated with significantly shorter procedural, total RF, and PV RF times compared to SV.
• First-pass PV isolation rates were higher in the HFLTV group (66.6% vs. 63.8%).
• At 12 months, the HFLTV group demonstrated superior freedom from all-atrial arrhythmia (85.6% vs. 79.3%), fewer AF-related symptoms (12.5% vs. 18.9%), and reduced hospitalizations (1.4% vs. 4.7%).

Conclusions:

• HFLTV ventilation is a safe and effective strategy for PAF catheter ablation.
• This technique improves long-term outcomes, including reduced arrhythmia recurrence, symptoms, and hospitalizations.
• Shorter procedural times and enhanced first-pass isolation are key benefits of HFLTV ventilation.