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Very Low Tidal Volume, High Frequency Ventilation in Atrial Fibrillation Ablation: A Systematic Review
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  • Anis John Kadado,
  • Kyle Gobeil,
  • Fadi Fakhoury,
  • Abdullah Pervaiz,
  • Fadi Chalhoub
Anis John Kadado
University of Massachusetts Medical School - Baystate Campus

Corresponding Author:[email protected]

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Kyle Gobeil
University of Massachusetts Medical School - Baystate Campus
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Fadi Fakhoury
Centre Hospitalo-Universitaire Caremeau
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Abdullah Pervaiz
Baystate Medical Center
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Fadi Chalhoub
University of Massachusetts Medical School - Baystate Campus
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Abstract

Introduction Ventilation strategies in atrial fibrillation ablation affect procedure outcomes by influencing catheter stability. Studies have highlighted favorable atrial fibrillation (AF) ablation outcomes with the use of high frequency jet ventilation (HFJV) which has shown to improve lesion durability, energy delivery and tissue contact. However, this mode of ventilation is not readily available. In this systematic review we highlight the available data on the use of very low tidal volume, high frequency ventilation using standard ventilators, that aims to provide settings similar to HFJV during AF ablations. Methods Using a combination of search terms in databases and manual searches in bibliographies of identified articles, we reviewed all published data reported in the English language on the use of very low tidal volume with high frequency ventilation during atrial fibrillation ablation. Results A total of 4 manuscripts were identified; 3 cohort studies and 1 case report. The utilization of standard ventilators with a high frequency, very low tidal volume ventilation strategy appears to closely mimic the catheter stability benefits that HFJV ventilators provide. Across the 3 cohort identified studies, the use of this ventilation strategy was associated with improved catheter stability, tissue contact, and decrease in radiofrequency time. No increased risk was identified compared to standard ventilation. Conclusion With a purpose of limiting thoracic excursion and cardiac movement, limited and sparse studies have shown improved outcomes with a very low tidal volume, high frequency ventilation strategy. Additional studies are needed to solidify this easily accessible and widely available mode of ventilation.