High-frequency low-tidal volume ventilation improves long-term success in radiofrequency catheter ablation of atrial fibrillation: a meta-analysis

Abstract Background High-frequency low-tidal volume ventilation (HFLTV) may improve catheter stability and enhance procedural success in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). However, long-term findings had been inconsistent. Purpose To investigate the effect of HFLTV on acute and long-term success of arrhythmia control in AF patients who underwent RF ablation. Methods We conducted a meta-analysis that included all studies which directly compared AF patients who underwent RF ablation under HFLTV versus those under standard ventilation. Primary outcomes included respectively acute first-pass pulmonary vein isolation (PVI) and long-term recurrence of AF/ atrial arrhythmias after 12 months. Mantel-Haenszel method was used to calculate the pooled Odds Ratio (OR) for the primary outcome. For continuous measures of secondary outcomes, including total procedure duration, ablation time and RF time, pooled standardized mean difference (SMD) was each derived using the inverse variance method. Heterogeneity was assessed using I2 statistic (cut-off >50%) and Cochran’s Q test. Fixed versus random-effects models were adopted according to heterogeneity. All analyses were performed using the "meta"/ "metafor" packages (R-Studio Version 2024). Results 5 cohort studies (publication period: 2019-2024) were identified and included in the meta-analysis (final sample: HFLTV n=460 versus standard ventilation n=705). HFLTV was significantly associated with lower risk of AF recurrence after 12 months (pooled OR= 0.62 [95% CI: 0.42-0.92]) (Panel A), as well as total atrial arrhythmia (OR=0.59 [95%CI: 0.42-0.81]), with no between-studies heterogeneity (I2 = 0%). Acutely, HFLTV was associated with higher probability of first-pass PVI with borderline statistical significance (OR=1.24 [95% CI: 0.94-1.63]). Furthermore, HFLTV was associated with significant reductions in total procedure time (-0.71 [95% CI: -1.00, -0.42], unit in S.D.), ablation time (-0.83 [95% CI: -1.07, -0.59]) and total RF time (-0.72 [95% CI: -0.85, -0.59]) (Heterogeneity I2 = 76%) Panel B). Notably, there was nil effect modification by paroxysmal or persistent AF(P>0.05). All studies reported nil major complications in either group. Conclusions HFLTV is associated with improved long-term success of arrhythmia control in AF patients who undergo RF catheter ablation, regardless of paroxysmal or persistent status.Figure A Figure B