Influence of High-Frequency Low-Tidal Volume Versus Jet Ventilation on Acute and Long-Term Outcomes Following Pulmonary Vein Isolation

Abstract

Introduction

Use of high-frequency low-tidal volume (HFLTV) and high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) improves acute procedural success and long-term outcomes compared to conventional ventilation. However, the impact of HFLTV compared to HFJV on acute and long-term outcomes is unknown.

Methods

We prospectively identified 1039 patients who underwent first-time PVI or PVI with posterior wall isolation (PWI) at our institution between 2022 and 2024 with HFLTV or HFJV. Acute procedural and safety outcomes were analyzed. Twelve-month arrhythmia-free survival was evaluated using the Kaplan-Meier and Cox proportional hazards method.

Results

After excluding 44 patients who required discontinuation of HFJV, 860 patients receiving HFJV were compared with 179 receiving HFLTV ventilation. Mean age was 65 years, 93% were White, 30% female and 53% had paroxysmal AF. First-pass isolation (FPI) rates were similar between ventilation strategies. HFLTV was associated with a higher rate of intraprocedural hypotension (31% vs 23%, p = 0.02). Complications were generally minor and comparable between groups. Arrhythmia recurrence rates at 12 months were similar (HR: 0.89, p = 0.55). There was a trend toward improved outcomes when FPI was achieved for both pulmonary veins in either group.

Conclusion

In this observational cohort, no significant differences in acute procedural outcomes, safety outcomes, or long-term arrhythmia recurrence were observed between HFLTV and HFJV. Given the specialized equipment and operator training required for HFJV and its non-negligible rate of discontinuation, HFLTV may offer a modest practical advantage in routine clinical practice.