J Cardiothorac Vasc Anesth. 2026 Jul;40(7):2069-2075. doi: 10.1053/j.jvca.2026.03.022. Epub 2026 Mar 18.
ABSTRACT
OBJECTIVES: To evaluate the association between ventilation strategy and catheter-tissue interaction, lesion characteristics, and procedural metrics during pediatric supraventricular tachycardia ablation.
DESIGN: Prospective observational study.
SETTING: Tertiary pediatric electrophysiology center.
PARTICIPANTS: A total of 133 consecutive patients aged < 18 lt; 18 years who underwent cardiac radiofrequency (RF) ablation between June and September 2025 were included. Patients were grouped according to ventilation strategy: high-frequency low-tidal volume (HFLTV) ventilation (n = 65), standard ventilation (SV) (n = 32), and controlled apnea (n = 36).
INTERVENTIONS: No interventions were performed. This was a prospective observational study in which ventilation strategy was determined by the attending anesthesiologist according to routine clinical practice and individual clinical judgment. The investigators had no role in selecting or modifying the ventilation approach. For analytical purposes, ventilation modes applied during routine care were classified into 3 categories: HFLTV ventilation, standard volume-controlled ventilation, and intermittent controlled apnea.
MEASUREMENTS AND MAIN RESULTS: The primary variable was mean contact force (MCF). Secondary outcomes included impedance metrics, operator-rated procedural quality score (PQS, scale of 1-10), number of lesions, RF application time, and total procedure duration. Baseline demographic and arrhythmia characteristics were similar among groups. HFLTV ventilation yielded significantly higher MCF (median, 7 g) compared with SV (median, 4 g; p < 0.001) and apnea (median, 5 g; p < 0.001), as well as higher PQS (8.1 ± 1.0) than SV (7.0 ± 2.0, p < 0.001) and apnea (7.1 ± 1.0, p < 0.001). Minimum and mean impedance values were lower in the HFLTV group, suggesting more favorable catheter-tissue interaction. RF time and overall procedure duration were similar across the groups. No ventilation-related complications were observed.
CONCLUSIONS: This prospective observational study found that different ventilation strategies influenced catheter-tissue interaction and procedural metrics during pediatric RF ablation. Notably, HFLTV ventilation was linked to higher contact force metrics. Additional research is necessary to verify these results.
PMID:42301726 | DOI:10.1053/j.jvca.2026.03.022