PO-01-030 HIGH-FREQUENCY LOW-TIDAL VOLUME MECHANICAL VENTILATION IS ASSOCIATED WITH IMPROVED ACUTE AND LONG-TERM OUTCOMES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILLATION ABLATION

Abstract

The cornerstone of atrial fibrillation (AF) ablation has been durable pulmonary vein isolation, which is achieve through adequate energy delivery to the myocardium. One of the most important factors is catheter stability. Several strategies have been described to improve catheter stability, including brief periods of apnea during ablation and the use of JET ventilation. However, they have several limitations and potential complications. High-frequency, low-tidal-volume (HFLTV) ventilation may be a simpler and safer alternative while still providing similar benefits. Examine the impact of HFLTV during radiofrequency (RF) ablation of AF on acute and long-term clinical outcomes in the REAL-AF Registry. A total 745 patients from 25 institutions were prospectively enrolled in a multicenter RF AF ablation registry (REAL-AF) from January 2019 to May 2021. Conventional ventilation only was used up until April 2020 [standard ventilation (SV) group] when HFLTV was implemented progressively at different centers (30 breaths/min and tidal volume 200ml). High-power, short-duration ablation with 40-50 watts was used in all cases, and other ablation parameters remained unchanged. Procedural characteristics, acute outcomes, freedom from all-atrial arrhythmias, and incidence of severe anesthesia and procedural relate adverse events (AE) were compared. Patients in the HFLTV group (n=216) had significantly shorter total RF Time (15.6±7.9 vs. 22.6±10.3, p<0.001) and procedural times (71.5±32.6 vs. 95.2±45.1, p<0.001) when compared to SV group (n=529). First-pass pulmonary vein (PV) isolation rates were higher in the HFLTV group [(left PVs: 92% vs. 86%, p=0.02 and right PVs: 76% vs. 74%, p=0.355)] in models adjusting for patient comorbidities. HFLTV was also associated with lower all-atrial arrhythmia recurrence (14.1% vs 20%, p=0.043) when adjusted for covariates. AEs at 30-day follow-up were similar. At 12 months, patients in the HFLTV had fewer symptoms 24.5% vs. 32.5%, p=0.031 and unplanned hospitalizations (0.5% vs. 3.6%, p=0.017). HFLTV mechanical ventilation during RF AF ablation was associated with improved procedure efficiency, first pass isolation and freedom from all-atrial arrhythmias at 12-month follow up without an increase in complications.