# The impact of sedation strategy on catheter stability in radiofrequency ablation for atrial fibrillation

## TL;DR

This study shows that general anesthesia with high-frequency jet ventilation improves catheter stability during heart ablation procedures for atrial fibrillation.

## Contribution

The study introduces a novel method to objectively measure catheter stability using XYZ coordinates during radiofrequency ablation.

## Key findings

- General anesthesia improved catheter stability compared to conscious sedation.
- Adding high-frequency jet ventilation to general anesthesia further improved catheter stability.
- Catheter stability can be objectively measured using XYZ coordinate standard deviation.

## Abstract

General anesthesia (GA) in radiofrequency ablation (RFA) for atrial fibrillation (AF) increases single procedure success rates and shortens procedure times vs conscious sedation (CS). In addition, high-frequency jet ventilation (HFJV) is associated with lower AF recurrence rates than conventional ventilation. Little data exist regarding the impact of sedation strategy on objective catheter stability and how this affects outcomes.

This study aimed to (1) measure catheter stability using the standard deviation (SD) of XYZ coordinates of catheter location, obtained in patients undergoing RFA for AF, and (2) compare catheter stability in CS, GA, and GA + HFJV groups.

All patients who underwent AF RFA at our center from April 2023 to June 2024 were eligible for inclusion in the study. Catheter stability was assessed using XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module. The median SD of XYZ coordinates per ablation lesion was used to determine catheter stability.

A total of 28 patients were included in the study, 8 in the CS group, 10 in the GA group, and 10 in the GA + HFJV group; 1,979,105 XYZ coordinates of RFA catheter location were analyzed. GA demonstrated an improvement in catheter stability compared with CS (median [interquartile range]) (0.54 [0.3–0.89] vs 1.51 [0.95–2.3], P < .001). GA + HFJV demonstrated further improvement in catheter stability vs GA (0.47 [0.25–0.87], P = .017).

The SD of XYZ coordinates of catheter location, obtained via the CARTO 3 VisiTag module, can be used to assess catheter stability during AF RFA. GA + HFJV offers superior catheter stability compared with GA and CS.