High-Frequency Low-Tidal Volume Ventilation Improves Long-Term Clinical Outcomes in Persistent AF Ablation: Multicenter Prospective Study

Abstract

Background: High-frequency low-tidal-volume (HFLTV) ventilation increases the efficacy and efficiency of catheter ablation of paroxysmal atrial fibrillation (PAF). Whether those benefits can be extrapolated to RFCA of persistent AF (PeAF) is undetermined.

Objective: To evaluate whether using HFLTV ventilation during catheter ablation in patients with PeAF, is associated with improved procedural and clinical outcomes when compared to standard ventilation (SV).

Methods: In this prospective multicenter registry (REAL-AF) patients who underwent catheter ablation for PeAF using either HFLTV or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included long-term clinical outcomes, procedural characteristics and complications.

Results: A total of 185 patients were included (HFLTV=81 vs. SV=104) in the analysis. There was no difference in baseline characteristics between groups. Procedural time (88.7{plus minus}33.6 vs. 122.8{plus minus}51.6, p<0.001), total RF time (20.6{plus minus}9.3 vs. 29.6{plus minus}12.2, p<0.001), and PV RF time (13.2{plus minus}6.1 vs. 20.5{plus minus}8.6, p<0.001) were significantly shorter using HFLTV when compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation when compared with SV (79% vs. 68%; HR 0.52, 95% CI [0.29-0.93], Log-rank p=0.033), indicating a 34% relative risk reduction and an 11% absolute risk reduction in all-atrial arrhythmias recurrence. There was no difference in long-term procedural-related complications between the groups (p=0.190).

Conclusion: In patients undergoing RFCA with PVI+PWI for PeAF, the use of HFLTV ventilation resulted in 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.

Note:
Trial Registration Details: “Real-World Experience of Catheter Ablation for the Treatment of Paroxysmal and Persistent Atrial Fibrillation”, NCT04088071)

Funding Information: The REAL-AF registry is funded through an investigator initiatedresearch grant (Dr Osorio, principal investigator) from BiosenseWebster.

Declaration of Interests: Dr Osorio, Dr Zei, Dr Sauer and Dr Romero report consulting and research support from Biosense Webster. Dr Silverstein reports consulting and honoraria from Biosense Webster. Dr D’Souza, Dr Oza, Dr Sharma and DrRajendra report consulting from Biosense Webster. Dr Thosani reports physician education from Biosense Webster. The other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethics Approval Statement: The REAL-AF registry received approval from the WCG Institutional Review Board on October 31, 2018. Additionally, the prospective registry obtained approval from the institutional review boards of each participating center.

Keywords: catheter ablation, high-frequency low-tidal volume ventilation, persistent atrial fibrillation, posterior wall isolation, pulmonary vein isolation