Association of HFLTVV With Force-Time Integral and Ablation Index During Pulmonary Vein Isolation

In catheter ablation of atrial fibrillation (AF), durable lesion formation is essential for successful pulmonary vein isolation (PVI). Force-time integral (FTI) is an established lesion metric that reflects the cumulative effect of contact force (CF) and radiofrequency (RF) application time and has been associated with lesion durability. Although high-frequency low-tidal volume ventilation (HFLTVV) has been associated with improved procedural outcomes, lesion-level evidence in the era of contact force-guided ablation remains limited. We aimed to evaluate the association between HFLTVV and lesion metrics during PVI.

This single-center retrospective study included patients with paroxysmal AF undergoing first-time RF PVI. Procedures were performed during the standard ventilation (SV) and the HFLTVV eras, with CF targeted at 10-12 g. Lesion parameters, including RF application time, average CF, ablation index (AI), FTI, and impedance drop, were extracted from CARTONET and analyzed overall and by pulmonary vein region. Respiratory effects were assessed using arterial blood gas analysis. Compared with SV, HFLTVV was associated with significantly higher FTI and AI (FTI: 268.8 ± 31.5 vs 235.2 ± 21.7 g·s; AI: 459.0 ± 16.8 vs 437.1 ± 13.4; both p <0.001), despite similar CF and RF application time. Findings were consistent across pulmonary vein regions. In multivariable analyses adjusting for baseline characteristics, HFLTVV remained independently associated with higher FTI and AI (both p <0.001). Procedural duration and arrhythmia recurrence were similar between groups. Arterial blood gas analysis demonstrated no clinically significant CO₂ retention.

HFLTVV was associated with higher FTI and AI under comparable CF and RF application time. These findings suggest that HFLTVV may influence lesion metrics during AF ablation and warrant further investigation.