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Influence of High-Frequency Low-Tidal Volume Versus Jet Ventilation on Acute and Long-Term Outcomes Following
Daniel Villarreal1, Juliana Perez-Pinzon2, Andre d'Avila1
1Harvard-Thorndike Arrhythmia Institute, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, Massachusetts, USA.
Introduction:
Use of high-frequency low-tidal volume (HFLTV) and high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) improves acute procedural success and long-term outcomes compared to conventional ventilation. However, the impact of HFLTV compared to HFJV on acute and long-term outcomes is unknown.
Methods:
We prospectively identified 1039 patients who underwent first-time PVI or PVI with posterior wall isolation (PWI) at our institution between 2022 and 2024 with HFLTV or HFJV. Acute procedural and safety outcomes were analyzed. Twelve-month arrhythmia-free survival was evaluated using the Kaplan-Meier and Cox proportional hazards method.
Results:
After excluding 44 patients who required discontinuation of HFJV, 860 patients receiving HFJV were compared with 179 receiving HFLTV ventilation. Mean age was 65 years, 93% were White, 30% female and 53% had paroxysmal AF. First-pass isolation (FPI) rates were similar between ventilation strategies. HFLTV was associated with a higher rate of intraprocedural hypotension (31% vs 23%, p = 0.02). Complications were generally minor and comparable between groups. Arrhythmia recurrence rates at 12 months were similar (HR: 0.89, p = 0.55). There was a trend toward improved outcomes when FPI was achieved for both pulmonary veins in either group.
Conclusion:
In this observational cohort, no significant differences in acute procedural outcomes, safety outcomes, or long-term arrhythmia recurrence were observed between HFLTV and HFJV. Given the specialized equipment and operator training required for HFJV and its non-negligible rate of discontinuation, HFLTV may offer a modest practical advantage in routine clinical practice.
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