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.

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.