Abstract 15720: A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation
Introduction: Catheter stability is an important factor in ablation success and may be affected by changes in intrathoracic pressure related to mechanical ventilation. There are few data on the effects of ventilation on catheter stability during ablation procedures in children and young adults. We prospectively characterized the effects of ventilation parameters on catheter movement, with a goal of determining the optimal mode of ventilation for pediatric ablation procedures.
Methods: Subjects < 25 years undergoing ablation for SVT or WPW at 2 centers from 3/15-6/16 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H20 (PEEP) or 0 cm H2O (ZEEP). The ablation catheter was moved to pre-determined standard annular positions [right posterior septal (RPS), right lateral (RL), +/- left lateral (LL)], and movement of the catheter tip was measured using 3D electroanatomic mapping systems under 2 conditions: small tidal volume (STV) (3-5 mL/kg) or large TV (LTV) (6-8 mL/kg), with rate adjusted to achieve equivalent minute ventilation. Multivariate analysis was conducted using a generalized linear mixed model to evaluate the effects of TV, PEEP, annular position, and patient BSA on catheter movement.
Results: 50 subjects [mean age 13.8 years; 24 (48%) PEEP] were enrolled for a total of 234 separate observations of catheter movement: 100 RPS, 100 RL, 34 LL. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (RPS: 2.4 ± 1.4 vs. 5.0 ± 3.2 mm, p <0.001; RL: 2.4 ± 1.3 vs. 5.9 ± 3.5 mm, p < 0.001; LL: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.001). Presence or absence of PEEP had no effect on catheter movement. In multivariate analysis, STV was associated with a 3.2 +/- 0.4 mm reduction in movement (p < 0.001), and LL location predicted a 1.4 +/- 0.8 mm decrease (p=0.002).
Conclusions: STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position. A STV strategy may be the preferred approach for mechanical ventilation during pediatric ablations.
Author Disclosures: C.M. Janson: None. S.R. Ceresnak: None. A.M. Dubin: None. K.S. Motonaga: None. G.E. Mann: None. M. Kahana: None. I. Fitz-James: None. L. Wise-Faberowski: None. K. Kamra: None. L. Nappo: None. A. Trela: None. J.M. Choi: None. R.H. Pass: None.
- © 2016 by American Heart Association, Inc.