Very Low Tidal Volume, High Frequency Ventilation in Atrial Fibrillation
Ablation: A Systematic Review
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.