Journal of cardiothoracic and vascular anesthesia · 2026
Respiration-Related Catheter Displacement and Physiological Tolerance of High-Frequency Very Low Tidal Volume Ventilation With Peak Pressure Limitation During Atrial Fibrillation Ablation: A Prospective 1-Way Crossover Pilot Study.
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Ramírez-Paesano Carlos Rafael, Colina-Vargas Yerlin-Andrés, Teresi Lucio, Penela Diego, Falasconi Giulio, Amata Francesco, Tresandi Daniel, Cersosimo Angelica, Olive Josep Rodiera, Soto-Iglesias David, Marti-Almor Julio, Berruezo Antonio
Аннотация
OBJECTIVE: To evaluate whether high-frequency, very low tidal volume ventilation with controlled peak inspiratory pressure limitation (HFvLTV-cPP) is associated with reduced respiration-related catheter displacement during atrial fibrillation (AF) ablation, while maintaining short-term physiological tolerance.
DESIGN: Prospective, single-center, fixed-sequence within-patient crossover pilot study.
SETTING: Tertiary electrophysiology center.
PARTICIPANTS: Fifty-two consecutive eligible adult patients undergoing radiofrequency catheter ablation for AF under general anesthesia.
INTERVENTION: Standard ventilation followed by HFvLTV-cPP (50 breaths·min⁻¹, inspiratory-to-expiratory ratio 1:1, tidal volume titrated to minimize catheter displacement, peak inspiratory pressure ≤20 cmH2O), delivered using a standard anesthesia workstation.
MEASUREMENTS AND MAIN RESULTS: HFvLTV-cPP was associated with a marked reduction in catheter displacement (6.22 ± 2.18 mm v 1.23 ± 0.69 mm; -4.99 mm, p < 0.001), corresponding to ∼80% reduction. Contact force was similar. Partial pressure of carbon dioxide increased from 38.0 ± 4.9 to 49.9 ± 7.2 mmHg, with values >60 mmHg in 9.6% of patients. Oxygenation remained preserved. Plateau pressures were not increased, and driving pressure was lower. Mean arterial pressure decreased after induction but not after HFvLTV-cPP, with modest vasopressor use. No procedural complications occurred. Early recovery was rapid, without early respiratory or neurologic complications.
CONCLUSIONS: HFvLTV-cPP was associated with marked motion reduction and short-term physiological tolerance in a selected cohort. These findings represent a mechanistic signal and do not establish clinical benefit or safety. Randomized studies are required.
DESIGN: Prospective, single-center, fixed-sequence within-patient crossover pilot study.
SETTING: Tertiary electrophysiology center.
PARTICIPANTS: Fifty-two consecutive eligible adult patients undergoing radiofrequency catheter ablation for AF under general anesthesia.
INTERVENTION: Standard ventilation followed by HFvLTV-cPP (50 breaths·min⁻¹, inspiratory-to-expiratory ratio 1:1, tidal volume titrated to minimize catheter displacement, peak inspiratory pressure ≤20 cmH2O), delivered using a standard anesthesia workstation.
MEASUREMENTS AND MAIN RESULTS: HFvLTV-cPP was associated with a marked reduction in catheter displacement (6.22 ± 2.18 mm v 1.23 ± 0.69 mm; -4.99 mm, p < 0.001), corresponding to ∼80% reduction. Contact force was similar. Partial pressure of carbon dioxide increased from 38.0 ± 4.9 to 49.9 ± 7.2 mmHg, with values >60 mmHg in 9.6% of patients. Oxygenation remained preserved. Plateau pressures were not increased, and driving pressure was lower. Mean arterial pressure decreased after induction but not after HFvLTV-cPP, with modest vasopressor use. No procedural complications occurred. Early recovery was rapid, without early respiratory or neurologic complications.
CONCLUSIONS: HFvLTV-cPP was associated with marked motion reduction and short-term physiological tolerance in a selected cohort. These findings represent a mechanistic signal and do not establish clinical benefit or safety. Randomized studies are required.