Initiation of a High-Frequency Jet Ventilation Strategy for Catheter Ablation for Atrial Fibrillation

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.

Eliminating the effects of motion during radiofrequency lesion delivery using a novel contact‐force controller

“…Rapid pacing has been shown to reduce the standard deviation in force by less than 1 g compared to its nonpaced counterpart, and its effectiveness is dependent on regional anatomical location within the LA . In a study examining almost 30 000 RF applications, HFJV only reduced force variability index by 0.06 on average in comparison with normal ventilation . In contrast, to achieve optimal force variability based on the variability criteria of CFV (<5 g ) and RSD (<30%), the CFC reduced standard deviation in the force profiles by 6.3 g on average and the force variability index by 0.21.…”

“…Systolo‐diastolic cardiac motion and respiration are the primary contributors to variability in contact force . Clinical techniques used to mitigate their effect include rapid atrial pacing, high‐frequency jet ventilation (HFJV), and induced apnea . Rapid pacing has been shown to reduce the standard deviation in force by less than 1 g compared to its nonpaced counterpart, and its effectiveness is dependent on regional anatomical location within the LA .…”

Rapid pacing and high‐frequency jet ventilation additively improve catheter stability during atrial fibrillation ablation

“…Patients who received HFJV had decreased incidence of acute and chronic pulmonary vein reconnection and required fewer repeat procedures at 1 year 10 . Another study demonstrated a decreased rate of arrhythmia recurrence with HFJV, though the effect was only significant in ablations for paroxysmal atrial fibrillation and not for persistent atrial fibrillation 11 …”

Ablation of Refractory Papillary Muscle Ventricular Tachycardia Warranting Multiple Adjunctive Ablation Techniques: A Combined Approach for Success

“…Further, investigators reported a significant improvement was achieved in the maintenance of a level of contact force of more than 5 g and a higher mean force variability index was realized with HFJV in comparison with standard ventilation (p ≤ 0.001), facilitating improved lesion delivery and ablation-line integrity. 25 Prior to this study, Kumar et al demonstrated the benefit of catheter stability afforded by regulating ventilation and reported significant improvement in the average force-time integral during apnea as compared with standard ventilation. 26 While these studies focused on atrial ablations, the conceptual experience is potentially applicable to ventricular ablations as well, although we are unaware of any trials using the principle of HFJV during VT ablation published at this time.…”