Document Detail


High-frequency jet ventilation: utility in posterior left atrial catheter ablation.
MedLine Citation:
PMID:  16399046     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. OBJECTIVES: 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. CONCLUSION: 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.
Authors:
Joseph S Goode; Renee L Taylor; Charles W Buffington; Miroslav M Klain; David Schwartzman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-09     Completed Date:  2006-03-16     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  13-9     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity / physiology
Blood Pressure / physiology
Blood Volume / physiology
Catheter Ablation / methods*
Electrocardiography
Female
Heart Atria / physiopathology,  surgery*
High-Frequency Jet Ventilation*
Humans
Intermittent Positive-Pressure Ventilation
Male
Middle Aged
Prospective Studies
Pulmonary Veins / physiopathology
Retrospective Studies
Temperature
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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