Jet ventilation and hemodynamic stability during pulmonary vein isolation: ventilatory and hemodynamic outcomes from a randomized controlled trial (Secondary analysis under EEG-Guided Total Intravenous Anesthesia).

BACKGROUND

High-Frequency Jet Ventilation (HFJV) improves catheter stability and shortens procedure time during pulmonary vein isolation (PVI) for atrial fibrillation. This study reports predefined secondary outcomes assessing the ventilatory and hemodynamic safety of HFJV under total intravenous anesthesia (TIVA).

METHODS

In this prospective, single-blind randomized controlled trial, 149 adult patients undergoing catheter-based PVI were assigned to HFJV or conventional volume-controlled ventilation. All patients received a standardized TIVA protocol guided by EEG-based depth monitoring. Secondary outcomes included arterial blood gases, hemodynamic tolerance (mean arterial pressure area under the curve < 65 mmHg [AUCNIBPM65] and root mean square < 65 mmHg [RMSNIBPM65]), vasopressor use, vasoactive-inotropic score (VIS), and recovery time.

RESULTS

Normocapnia was maintained in both groups, with comparable post-procedural PaCO₂ values (p = 0.085). However, PaCO₂ > 45 mmHg occurred more frequently in the HFJV group (18.7% vs 4.1%, p = 0.01). Oxygenation was preserved, with no desaturation events in either arm (AUCSpO₂ < 90%: 0%·min in both groups) and no difference in PaO₂ (p = 0.14). HFJV was associated with significantly lower hypotension exposure (AUCNIBP < 65: 12,255 vs 46,232 mmHg·min; p = 0.007) and reduced severity (RMSNIBP < 65: 0.7 vs 2.2 mmHg; p = 0.011), while vasopressor use (p = 0.077), VIS (p = 0.10), lactate (p = 0.60), and recovery time (53 vs 54 min; p = 0.70) were similar.

CONCLUSIONS

Under TIVA with EEG guidance, HFJV was associated with lower cumulative exposure to mild intraoperative hypotension than conventional ventilation during PVI, while maintaining adequate oxygenation and overall normocapnia. The absolute magnitude of the hemodynamic difference was small, and these exploratory, hypothesis-generating findings should be confirmed in trials powered on patient-centered hemodynamic endpoints.

TRIAL REGISTRATION: This manuscript is reported in accordance with the CONSORT 2010 statement where applicable. Australian New Zealand Clinical Trials Registry ACTRN12623000982617, registration effective September 8, 2023, retrospective relative to enrollment. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385792.