Author + information
- Received February 26, 2018
- Revision received July 27, 2018
- Accepted August 15, 2018
- Published online October 31, 2018.
- Bhradeev Sivasambu, MD,
- Joe B. Hakim, BS,
- Viachaslau Barodka, MD,
- Jonathan Chrispin, MD,
- Ronald D. Berger, MD, PhD,
- Hiroshi Ashikaga, MD, PhD,
- Luisa Ciuffo, MD,
- Susumu Tao, MD,
- Hugh Calkins, MD,
- Joseph E. Marine, MD,
- Natalia Trayanova, PhD and
- David D. Spragg, MD∗ ()
- ↵∗Address for correspondence:
Dr. David Spragg, Johns Hopkins Heart and Vascular Institute, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland 21287.
Objectives The aim of the current investigation is to examine whether use of high-frequency jet ventilation (HFJV) during pulmonary vein isolation (PVI) performed with force-sensing catheters is associated with improved outcomes.
Background Catheter ablation is well established as therapy for symptomatic atrial fibrillation (AF). Reconnection following PVI is commonly observed during repeat ablation procedures. Technologies that may optimize catheter stability and lesion delivery include both force-sensing ablation catheters and HFJV.
Methods Patients undergoing PVI at Johns Hopkins Hospital were prospectively enrolled in a registry. The study compared procedural characteristics, adverse event rates, and 1-year procedural outcomes in patients undergoing PVI supported either by standard ventilation or HFJV. Patient and procedural aspects were otherwise constant.
Results Eighty-four HFJV patients and 84 matched control patients with 1-year outcome data were identified. Atrial arrhythmia recurrence occurred in 26 of 84 HFJV patients (31%) and 42 of 84 control patients (50%; p = 0.019). In patients with paroxysmal AF, arrhythmia recurrence in HFJV and control patients was 27.3% and 47.3%, respectively (p = 0.045). In patients with persistent AF, arrhythmia recurrence rates were not significantly different (37.9% in HFJV patients, 55.2% in control patients; p = 0.184). On multivariate analysis, HFJV was independently associated with improved freedom from arrhythmia recurrence. Vasopressor use during HFJV cases was significantly higher than during standard ventilation (79.7% vs. 22.4%; p = 0.001). Indices of catheter stability and contact force adequacy were significantly higher in the HFJV patients than in control patients. Complication rates in the 2 groups were similarly low.
Conclusions Use of HFJV in patients undergoing PVI with radiofrequency force-sensing catheters is associated with improved outcomes, without appreciable increase in adverse procedural events.
Funding for this research was provided in part by the Edward St. John Fund for AF Research, the Roz and Marvin H. Weiner and Family Foundation, the Dr. Francis P. Chiaramonte Foundation, the Marilyn and Christian Poindexter Arrhythmia Research Fund, Norbert and Louise Grunwald Cardiac Arrhythmia Research Fund, and the Mr. & Mrs. Larry Small AF Research Fund. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 26, 2018.
- Revision received July 27, 2018.
- Accepted August 15, 2018.
- 2018 American College of Cardiology Foundation
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