Initiation of a High-Frequency Jet Ventilation Strategy for Catheter Ablation for Atrial Fibrillation: Safety and Outcomes Data

Abstract

Objectives: The aim of the current investigation is to examine whether use of high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) performed with force-sensing catheters is associated with improved outcomes.

Background: Catheter ablation is well established as therapy for symptomatic atrial fibrillation (AF). Reconnection following PVI is commonly observed during repeat ablation procedures. Technologies that may optimize catheter stability and lesion delivery include both force-sensing ablation catheters and HFJV.

Methods: Patients undergoing PVI at Johns Hopkins Hospital were prospectively enrolled in a registry. The study compared procedural characteristics, adverse event rates, and 1-year procedural outcomes in patients undergoing PVI supported either by standard ventilation or HFJV. Patient and procedural aspects were otherwise constant.

Results: Eighty-four HFJV patients and 84 matched control patients with 1-year outcome data were identified. Atrial arrhythmia recurrence occurred in 26 of 84 HFJV patients (31%) and 42 of 84 control patients (50%; p = 0.019). In patients with paroxysmal AF, arrhythmia recurrence in HFJV and control patients was 27.3% and 47.3%, respectively (p = 0.045). In patients with persistent AF, arrhythmia recurrence rates were not significantly different (37.9% in HFJV patients, 55.2% in control patients; p = 0.184). On multivariate analysis, HFJV was independently associated with improved freedom from arrhythmia recurrence. Vasopressor use during HFJV cases was significantly higher than during standard ventilation (79.7% vs. 22.4%; p = 0.001). Indices of catheter stability and contact force adequacy were significantly higher in the HFJV patients than in control patients. Complication rates in the 2 groups were similarly low.

Conclusions: Use of HFJV in patients undergoing PVI with radiofrequency force-sensing catheters is associated with improved outcomes, without appreciable increase in adverse procedural events.

Keywords: atrial fibrillation ablation; high frequency jet ventilation; pulmonary vein isolation.