High-frequency low-tidal-volume ventilation reduces loop catheter displacement during pulsed field ablation for pulmonary vein isolation

Respiratory motion during pulmonary vein isolation (PVI) using pulsed field ablation (PFA) can compromise catheter stability and procedural precision. Although high-frequency, low-tidal-volume ventilation (HFLTV) has been proposed to reduce diaphragmatic excursion, quantitative data evaluating its effect on catheter tip displacement during PFA are limited. This retrospective observational study included 28 consecutive patients with atrial fibrillation (paroxysmal, n = 21; persistent, n = 7) who underwent PVI using PFA under general anesthesia. Catheter stability was quantitatively assessed by measuring the vertical displacement of the distal catheter tip during a single respiratory cycle at the right and left inferior pulmonary veins under intermittent positive pressure ventilation and HFLTV within the same patients. HFLTV significantly reduced catheter tip displacement at both pulmonary veins compared with intermittent positive pressure ventilation. Median displacement at the right inferior pulmonary vein decreased from 2.7 to 1.4 mm (median paired difference, 1.15 mm; 95% CI 0.25-2.25; p = 0.003), and at the left inferior pulmonary vein from 4.8 to 1.3 mm (median paired difference, 2.95 mm; 95% CI 1.50-3.80; p < 0.001). End-tidal carbon dioxide levels increased modestly during HFLTV without clinically significant hemodynamic instability. HFLTV significantly reduced catheter tip displacement during PVI using PFA. These findings suggest that HFLTV may be a useful ventilatory strategy for improving catheter stability during PFA procedures under general anesthesia.