High-frequency jet ventilation: utility in posterior left atrial catheter ablation.
BACKGROUND
Percutaneous catheter ablation in the posterior left atrium (LA) is a technically demanding procedure that in our experience is best accomplished using general anesthesia, including endotracheal intubation and mechanical ventilation. However, using conventional intermittent positive-pressure ventilation (IPPV) technique, we were dissatisfied with motion of the posterior LA. This occurred during changes in lung volume, which destabilized ablation electrode-endocardial contact. We hypothesized that use of high-frequency jet ventilation (HFJV), a low-volume, fast-rate technique, would reduce posterior LA motion and thus facilitate the ablation procedure.


OBJECTIVE
The purpose of this study was to demonstrate that, relative to IPPV, HFJV reduces posterior LA motion and facilitates catheter ablation in this region.


METHODS
Patients who underwent posterior LA ablation using HFJV (n = 36) were retrospectively compared with those in whom IPPV (n = 36) was used. Indices examined included number of radiofrequency energy applications, electrode temperature, and procedure time. A prospective direct comparison of the impact of HFJV and IPPV on LA volume and mechanical function was performed in an additional 10 patients.


RESULTS
Fewer ablation lesions were required in the HFJV group because of fewer incidences of ablation electrode dislodgment, resulting in significantly decreased procedure time. Although there was no significant difference in maximal electrode temperature achieved during radiofrequency application, temperature variation was diminished in the HFJV group. Direct comparison demonstrated that HFJV produced less variation in LA volume, pressure, pulmonary vein blood flow velocity, and posterior LA position than IPPV.


CONCLUSIONS
Relative to IPPV, HFJV yields a more stable posterior LA environment, thus facilitating catheter ablation. Use of HFJV may be applicable to other interventional cardiovascular procedures.
Goode
Joseph S
JS
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Taylor
Renee L
RL
Buffington
Charles W
CW
Klain
Miroslav M
MM
Schwartzman
David
D
D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006611:High-Frequency Jet Ventilation; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology; D012189:Retrospective Studies; D013696:Temperature; D013997:Time Factors