A Novel Approach to Optimized Ventilation Strategies in Patients with Atrial Fibrillation: A Subgroup Analysis of the Ablate-by-LAWT-Study
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Background : High-frequency ventilation remains largely unutilized in critically ill patients and existing literature does not demonstrate clinical benefit. Patients with atrial fibrillation (AF) included in the Ablate-by-LAWT-study underwent a specialized anesthesiologic protocol using higher-frequency (45-55/min), low-tidal volume (3.5-4 ml/kg ideal body weight) ventilation (HFLTV). Heart failure (HF) and post-capillary pulmonary hypertension (pcPH) are common in this population. Whereas conventional ventilation can increase intrathoracic pressure, HFLTV may offer both procedural and cardiorespiratory advantages. This analysis aims to investigate hemodynamic and respiratory effects of higher-frequency, lower tidal volume ventilation in comparison to conventional volume-controlled ventilation and to evaluate potential benefits for patients with or at risk for HF, pcPH and right ventricular (RV) dysfunction. Methods : 12 patients undergoing the HFLTV anesthesiology protocol were included in an analysis of left atrial pressure (LAP), blood gas and hemodynamic parameters, focusing on temporal progression of systolic LAP, partial arterial pressure of oxygen (PaO₂) and carbon dioxide (PaCO₂), and cardiac index (CI). Results : Systolic LAP decreased significantly after initiation of HFLTV [-3.33, 95% CI (-5.61 - 1.06)], while global respiratory function (PaO 2 , PaCO 2 ) remained stable. CI [-0.8, 95% CI (-1.092 – -0.448)] and heart rate [-9.0, 95% CI (-15.306 – -2.723)] increased, indicating improved hemodynamic performance without compromising oxygenation or carbon dioxide elimination. Conclusion : Using higher frequencies in mechanical ventilation has a significant impact on systolic LAP and CI. It suggests potential for stabilizing hemodynamics in critically ill patients with atrial fibrillation, post-capillary pulmonary hypertension, heart failure and right ventricular dysfunction undergoing general anesthesia. Randomized controlled trials are warranted for further investigation. Trial registration : The Ablate-by-LAWT-study was registered at ClinicalTrials.gov (January 2020, ID: NCT04218604).
