TY - JOUR
T1 - High-frequency low-tidal volume ventilation improves procedural and long-term clinical outcomes in persistent atrial fibrillation ablation
T2 - Prospective multicenter registry
AU - Osorio, Jose
AU - Hincapie, Daniela
AU - Varley, Allyson L.
AU - Silverstein, Joshua R.
AU - Matos, Carlos D.
AU - Thosani, Amit J.
AU - Thorne, Christopher
AU - D'Souza, Benjamin
AU - Alviz, Isabella
AU - Gabr, Mohamed
AU - Rajendra, Anil
AU - Oza, Saumil
AU - Sharma, Dinesh
AU - Hoyos, Carolina
AU - Singleton, Matthew J.
AU - Mareddy, Chinmaya
AU - Velasco, Alejandro
AU - Zei, Paul C.
AU - Sauer, William H.
AU - Romero, Jorge E.
N1 - Publisher Copyright:
© 2024 Heart Rhythm Society
PY - 2025/2
Y1 - 2025/2
N2 - Background: High-frequency, low-tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined. Objective: The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and long-term clinical outcomes compared to standard ventilation (SV). Methods: In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + posterior wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications. Results: A total of 210 patients were included (HFLTV=95 vs. SV=115) in the analysis. There were no differences in baseline characteristics between the groups. Procedural time (80 [66–103.5] minutes vs 110 [85–141] minutes; P <.001), total radiofrequency (RF) time (18.73 [13.93–26.53] minutes vs 26.15 [20.30–35.25] minutes; P <.001), and pulmonary vein RF time (11.35 [8.78–16.69] minutes vs 18 [13.74–24.14] minutes; P <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21–0.82]; P = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmia recurrence. There was no difference in long-term procedure-related complications between the groups (HFLTV 1.1% vs SV 0%, P = .270). Conclusion: In patients undergoing RFCA with PVI + PWI for PeAF, the use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV, while reporting a similar safety profile.
AB - Background: High-frequency, low-tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined. Objective: The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and long-term clinical outcomes compared to standard ventilation (SV). Methods: In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + posterior wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications. Results: A total of 210 patients were included (HFLTV=95 vs. SV=115) in the analysis. There were no differences in baseline characteristics between the groups. Procedural time (80 [66–103.5] minutes vs 110 [85–141] minutes; P <.001), total radiofrequency (RF) time (18.73 [13.93–26.53] minutes vs 26.15 [20.30–35.25] minutes; P <.001), and pulmonary vein RF time (11.35 [8.78–16.69] minutes vs 18 [13.74–24.14] minutes; P <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21–0.82]; P = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmia recurrence. There was no difference in long-term procedure-related complications between the groups (HFLTV 1.1% vs SV 0%, P = .270). Conclusion: In patients undergoing RFCA with PVI + PWI for PeAF, the use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV, while reporting a similar safety profile.
KW - High-frequency
KW - Persistent atrial fibrillation
KW - Posterior wall isolation
KW - Pulmonary vein isolation
KW - Radiofrequency catheter ablation
KW - low-tidal volume ventilation
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U2 - 10.1016/j.hrthm.2024.07.094
DO - 10.1016/j.hrthm.2024.07.094
M3 - Article
C2 - 39053748
AN - SCOPUS:85200549293
SN - 1547-5271
VL - 22
SP - 432
EP - 442
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -