%0 Journal Article
%T High-frequency, low tidal volume ventilation improves procedural and long-term clinical outcomes in persistent atrial fibrillation ablation: Prospective multicenter registry.
%A Osorio J
%A Hincapie D
%A Varley AL
%A Silverstein JR
%A Matos CD
%A Thosani AJ
%A Thorne C
%A D'Souza B
%A Alviz I
%A Gabr M
%A Rajendra A
%A Oza S
%A Sharma D
%A Hoyos C
%A Singleton MJ
%A Mareddy C
%A Velasco A
%A Zei PC
%A Sauer WH
%A Romero JE
%J Heart Rhythm
%V 0
%N 0
%D 2024 Jul 23
%M 39053748
%F 6.779
%R 10.1016/j.hrthm.2024.07.094
%X <B>BACKGROUND: </B>High-frequency, low tidal volume (HFLTV) ventilation increases the efficacy and efficiency of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation. Whether those benefits can be extrapolated to RFCA of persistent atrial fibrillation (PeAF) is undetermined.<BR><B>OBJECTIVE: </B>The purpose of this study was to evaluate whether using HFLTV ventilation during RFCA in patients with PeAF is associated with improved procedural and clinical outcomes compared to standard ventilation (SV).<BR><B>METHODS: </B>In this prospective multicenter registry (REAL-AF), patients who had undergone pulmonary vein isolation (PVI) + pulmonary wall isolation (PWI) for PeAF using either HFLTV ventilation or SV were included. The primary efficacy outcome was freedom from all-atrial arrhythmias at 12 months. Secondary outcomes included procedural and long-term clinical outcomes and complications.<BR><B>RESULTS: </B>A total of 210 patients were included (95 HFLTV, 115 SV) in the analysis. There was no difference in baseline characteristics between groups. Procedural time (80 [63-103.5] minutes vs110 [85-141] minutes; P <.001), total radiofrequency (RF) time (18.73 [13.93-26.53] minutes vs 26.15 [20.30-35.25] minutes; P <.001), and pulmonary vein RF time (11.35 [8.78-16.69] minutes vs 18 [13.74-24.14] minutes; P <.001) were significantly shorter using HFLTV ventilation compared with SV. Freedom from all-atrial arrhythmias was significantly higher with HFLTV ventilation compared with SV (82.1% vs 68.7%; hazard ratio 0.41; 95% confidence interval [0.21-0.82]; P = .012), indicating a 43% relative risk reduction and a 13.4% absolute risk reduction in all-atrial arrhythmias recurrence. There was no difference in long-term procedural-related complications between the groups (P = .270).<BR><B>CONCLUSIONS: </B>In patients undergoing RFCA with PVI + PWI for PeAF, use of HFLTV ventilation was associated with higher freedom from all-atrial arrhythmias at 12-month follow-up, with significantly shorter procedural and RF times compared to SV but with similar safety profile.