Procedural and Clinical Outcomes of High-Frequency Low-Tidal Volume Ventilation Plus Rapid-Atrial Pacing in Paroxysmal Atrial Fibrillation Ablation.

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Electrophysiology Pub Date : 2025-04-18 DOI:10.1111/jce.16661

Paul C Zei, Daniela Hincapie, Joan Rodriguez-Taveras, Jose Osorio, Isabella Alviz, Andres F Miranda-Arboleda, Mohamed Gabr, Christopher Thorne, Joshua R Silverstein, Amit J Thosani, Allyson L Varley, Fernando Moreno, Daniel A Zapata, Benjamin D'Souza, Anil Rajendra, Saumil Oza, R N Linda Justice, Ana Baranowski, Huy Phan, Alejandro Velasco, Charles C Te, Matthew C Sackett, Matthew J Singleton, Anthony R Magnano, David Singh, Richard Kuk, Nathaniel A Steiger, William H Sauer, Jorge E Romero

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引用次数: 0

Abstract

Background: High-frequency low-tidal-volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal and persistent atrial fibrillation (AF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined.

Objective: To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of paroxysmal AF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone.

Methods: Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of paroxysmal AF using either HFLTV + RAP (500-600 msec) or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-month follow-up. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and procedure-related complications.

Results: A total of 545 patients were included in the analysis (HFLTV + RAP = 327 vs. HFLTV = 218). There were no significant differences in baseline characteristics between the groups. No differences were observed in procedural (HFLTV + RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p = 0.617) and RF (HFLTV + RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p = 0.620) times. Both groups showed a similar freedom from all-atrial arrhythmias at 12-month follow-up (HFLTV + RAP 82.68% vs. HFLTV 86.52%, HR = 1.43, 95% CI [0.94-2.16], p = 0.093). There were no significant differences in freedom from AF-related symptoms (HFLTV + RAP 91.4% vs. HFLTV 93.1%, p = 0.476) or AF-related hospitalizations (HFLTV + RAP 98.5% vs. HFLTV 97.2%, p = 0.320). Procedure-related complications were low in both groups (HFLTV + RAP 0.6% vs. HFLTV 0%, p = 0.247).

Conclusion: In patients undergoing RFCA for paroxysmal AF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.

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高频低潮气量通气加快速心房起搏治疗阵发性心房颤动消融的程序和临床结果。

背景：高频低潮气量（HFLTV）通气是一种安全且具有成本效益的策略，可提高阵发性和持续性心房颤动（AF）射频导管消融（RFCA）期间导管稳定性、第一遍肺静脉隔离和全房心律失常的自由。然而，在hfltv通气中增加快速心房起搏（RAP）的增量价值尚未确定。目的：评价阵发性房颤射频置换术中hfltv -通气联合RAP与单纯hfltv -通气相比对手术和远期临床结果的影响。方法：纳入来自REAL-AF前瞻性多中心注册的患者，这些患者在2020年4月至2023年2月期间使用HFLTV + RAP （500-600 msec）或HFLTV通气单独进行阵发性房颤RFCA。在12个月的随访中，主要结局是无房性心律失常。次要结局包括手术特征、长期临床结局和手术相关并发症。结果：共纳入545例患者（HFLTV + RAP = 327 vs HFLTV = 218）。两组间基线特征无显著差异。手术次数（HFLTV + RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p = 0.617）和射频次数（HFLTV + RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p = 0.620）无差异。在12个月的随访中，两组均显示出相似的全房性心律失常自由度（HFLTV + RAP 82.68% vs. HFLTV 86.52%, HR = 1.43, 95% CI [0.94-2.16], p = 0.093）。无房颤相关症状（HFLTV + RAP 91.4% vs. HFLTV 93.1%, p = 0.476）或房颤相关住院（HFLTV + RAP 98.5% vs. HFLTV 97.2%, p = 0.320）方面无显著差异。两组手术相关并发症发生率均较低（HFLTV + RAP为0.6%，HFLTV为0%，p = 0.247）。结论：在阵发性房颤患者接受RFCA时，在hfltv通气中加入RAP与改善手术和长期临床结果无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.