A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation

Christopher M. Janson, Scott R. Ceresnak, Jaeun Choi, Anne M. Dubin, Kara S. Motonaga, Glenn E. Mann, Madelyn Kahana, Ingrid A. Fitz-James, Lisa Wise-Faberowski, Komal Kamra, Lynn Nappo, Anthony Trela, Robert H. Pass

Research output: Contribution to journalArticle

Abstract

Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions. Subjects aged 5–25 years undergoing ablation for supraventricular tachycardia (SVT) or WPW at two centers from March 2015 to September 2016 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H2O (PEEP) or 0 cm H2O (ZEEP). Movement of the ablation catheter tip at standard annular positions was measured using 3D electroanatomic mapping systems under two conditions: small tidal volume (STV) (3–5 mL/kg) or large TV (LTV) (6–8 mL/kg). 58 subjects (mean age 13.8 years) were enrolled for a total of 266 separate observations of catheter movement. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (right posteroseptal: 2.5 ± 1.4 vs. 5.2 ± 3.1 mm, p < 0.0001; right lateral: 2.7 ± 1.6 vs. 6.3 ± 3.5 mm, p < 0.0001; left lateral: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.0001). The presence or absence of PEEP had no effect on catheter movement. In multivariable analysis, STV was associated with a 3.1-mm reduction in movement (95% CI 2.6–3.5, p < 0.0001), adjusting for end-expiratory pressure, annular location, and patient size. We conclude that STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position.

Original languageEnglish (US)
JournalPediatric Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Catheter Ablation
Tidal Volume
Artificial Respiration
Positive-Pressure Respiration
Ventilation
Pediatrics
Catheters
Supraventricular Tachycardia
Pressure

Keywords

  • Catheter ablation
  • Catheter stability
  • Electrophysiology
  • SVT
  • Ventilation
  • WPW

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation. / Janson, Christopher M.; Ceresnak, Scott R.; Choi, Jaeun; Dubin, Anne M.; Motonaga, Kara S.; Mann, Glenn E.; Kahana, Madelyn; Fitz-James, Ingrid A.; Wise-Faberowski, Lisa; Kamra, Komal; Nappo, Lynn; Trela, Anthony; Pass, Robert H.

In: Pediatric Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Janson, Christopher M. ; Ceresnak, Scott R. ; Choi, Jaeun ; Dubin, Anne M. ; Motonaga, Kara S. ; Mann, Glenn E. ; Kahana, Madelyn ; Fitz-James, Ingrid A. ; Wise-Faberowski, Lisa ; Kamra, Komal ; Nappo, Lynn ; Trela, Anthony ; Pass, Robert H. / A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation. In: Pediatric Cardiology. 2018.
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AU - Janson, Christopher M.

AU - Ceresnak, Scott R.

AU - Choi, Jaeun

AU - Dubin, Anne M.

AU - Motonaga, Kara S.

AU - Mann, Glenn E.

AU - Kahana, Madelyn

AU - Fitz-James, Ingrid A.

AU - Wise-Faberowski, Lisa

AU - Kamra, Komal

AU - Nappo, Lynn

AU - Trela, Anthony

AU - Pass, Robert H.

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N2 - Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions. Subjects aged 5–25 years undergoing ablation for supraventricular tachycardia (SVT) or WPW at two centers from March 2015 to September 2016 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H2O (PEEP) or 0 cm H2O (ZEEP). Movement of the ablation catheter tip at standard annular positions was measured using 3D electroanatomic mapping systems under two conditions: small tidal volume (STV) (3–5 mL/kg) or large TV (LTV) (6–8 mL/kg). 58 subjects (mean age 13.8 years) were enrolled for a total of 266 separate observations of catheter movement. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (right posteroseptal: 2.5 ± 1.4 vs. 5.2 ± 3.1 mm, p < 0.0001; right lateral: 2.7 ± 1.6 vs. 6.3 ± 3.5 mm, p < 0.0001; left lateral: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.0001). The presence or absence of PEEP had no effect on catheter movement. In multivariable analysis, STV was associated with a 3.1-mm reduction in movement (95% CI 2.6–3.5, p < 0.0001), adjusting for end-expiratory pressure, annular location, and patient size. We conclude that STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position.

AB - Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions. Subjects aged 5–25 years undergoing ablation for supraventricular tachycardia (SVT) or WPW at two centers from March 2015 to September 2016 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H2O (PEEP) or 0 cm H2O (ZEEP). Movement of the ablation catheter tip at standard annular positions was measured using 3D electroanatomic mapping systems under two conditions: small tidal volume (STV) (3–5 mL/kg) or large TV (LTV) (6–8 mL/kg). 58 subjects (mean age 13.8 years) were enrolled for a total of 266 separate observations of catheter movement. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (right posteroseptal: 2.5 ± 1.4 vs. 5.2 ± 3.1 mm, p < 0.0001; right lateral: 2.7 ± 1.6 vs. 6.3 ± 3.5 mm, p < 0.0001; left lateral: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.0001). The presence or absence of PEEP had no effect on catheter movement. In multivariable analysis, STV was associated with a 3.1-mm reduction in movement (95% CI 2.6–3.5, p < 0.0001), adjusting for end-expiratory pressure, annular location, and patient size. We conclude that STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position.

KW - Catheter ablation

KW - Catheter stability

KW - Electrophysiology

KW - SVT

KW - Ventilation

KW - WPW

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