Lesion characteristics using high-frequency low-tidal volume ventilation versus standard ventilation during ablation of paroxysmal atrial fibrillation

Introduction: High-frequency low-tidal-volume (HFLTV) ventilation during radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) has been shown to be superior to standard ventilation (SV) in terms of procedural efficiency, acute and long-term clinical outcomes. Our study aimed to compare ablation lesions characteristics utilizing HFLTV ventilation versus SV during RFCA of PAF. Methods: A retrospective analysis was conducted on patients who underwent pulmonary vein isolation (PVI) for PAF between August 2022 and March 2023, using high-power short-duration ablation. Thirty-five patients underwent RFCA with HFLTV ventilation and were matched with another cohort of 35 patients who underwent RFCA with SV. Parameters including ablation duration, contact force (CF), impedance drop, and ablation index were extracted from the CARTONET database for each ablation lesion. Results: A total of 70 patients were included (HFLTV = 35/2484 lesions, SV = 35/2830 lesions) in the analysis. There were no differences in baseline characteristics between the groups. While targeting the same ablation index, the HFLTV ventilation group demonstrated shorter average ablation duration per lesion (12.3 +/- 5.0 vs. 15.4 +/- 8.4 s, p < .001), higher average CF (17.0 +/- 8.5 vs. 10.5 +/- 4.6 g, p < .001), and greater impedance reduction (9.5 +/- 4.6 vs. 7.7 +/- 4.1 ohms, p < .001). HFLTV ventilation group also demonstrated shorter total procedural time (61.3 +/- 25.5 vs. 90.8 +/- 22.8 min, p < .001), ablation time (40.5 +/- 18.6 vs. 65.8 +/- 22.5 min, p < .001), and RF time (15.3 +/- 4.8 vs. 22.9 +/- 9.7 min, p < .001). Conclusion: HFLTV ventilation during PVI for PAF was associated with improved ablation lesion parameters and procedural efficiency compared to SV.