Related Experiment Video
Updated: Oct 16, 2026
Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation
Published on: August 25, 2022
High-Frequency Low-Tidal Volume Ventilation and Procedural Efficiency in Atrial Fibrillation Catheter Ablation: A
Gizem Özata Arslan1, Hikmet Yorgun2, Cem Çöteli2
1Department of Anaesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
Objectives:
To compare high-frequency low-tidal volume (HFLTV) ventilation with standard ventilation (SV) regarding procedural efficiency, airway mechanics, and clinical outcomes in atrial fibrillation (AF) catheter ablation.
Design:
Retrospective, observational, nonrandomized cohort study.
Setting:
Electrophysiology laboratory of a single tertiary-care university hospital.
Participants:
There were 160 consecutive eligible adults undergoing first-time AF radiofrequency ablation under general anesthesia between June 2023 and May 2024.
Interventions:
Patients received HFLTV (n = 80; respiratory rate 25-30 breaths/min, tidal volume 3-4 mL/kg, ETCO₂ maintained <50 mmHg) or SV (n = 80; tidal volume 6-8 mL/kg, respiratory rate 10-12 breaths/min) per attending anesthesiologist practice. All received propofol-remifentanil total intravenous anesthesia.
Measurements And Main Results:
Primary outcomes were total procedure time and radiofrequency ablation time; secondary outcomes were airway pressures, oxygenation, AF recurrence at 1 and 6 months, AF-related hospitalization, and complications. HFLTV was associated with lower median procedure time (110 v 128 minutes; p < .001) and ablation time (23 v 28 minutes; p < .001). Peak (14 v 18 cmH₂O) and minimum (13 v 15 cmH₂O) airway pressures were lower with HFLTV (both p < .001), whereas ETCO₂ and SpO₂ nadir were comparable. Multivariable regression identified HFLTV as an independent predictor of shorter ablation time (nonstandardized β=-5.48 minutes; 95% CI -7.05 to -3.91; p < .001). In exploratory analyses, recurrence at 1 month (7.5% v 15.0%; p = .211) and 6 months (13.8% v 18.8%; p = .520) and 6-month AF-related hospitalization (12.5% v 18.8%; p = .384) were numerically lower with HFLTV but confidence intervals were wide and included no difference.
Conclusion:
In a consecutive cohort including paroxysmal and persistent AF, HFLTV was associated with shorter procedure and ablation times and lower measured airway pressures without compromising gas exchange. Clinical outcome analyses were exploratory and hypothesis-generating, warranting prospective randomized evaluation.
