Category: High Frequency Jet Ventilation

Issues and Discussions Regarding High Frequency Jet Ventilation during Electrophysiology Procedures

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HRS HFJV 5088

Abstract Presented at the Heart Rhythm Society 2014 Annual Sessions, May 8, 2014

Patient Awareness of High Frequency Jet Ventilation to Minimize Cardiac Motion during Interventional ProceduresAuthors:
Jeffrey L. Williams MD MS FACC FHRS, David Lugg BS RCIS, Robert Gray BSN RN, Rose Benson CRNA, Marie A. DeFrancesco-Loukas CRNA, Paul J. Teiken MD. Heart Rhythm Center, The Good Samaritan Hospital, Lebanon Cardiology Associates, Lebanon Anesthesia Associates, Lebanon, PA.

Introduction: High frequency jet ventilation (HFJV) is used to minimize pulmonary and hence, cardiac motion during interventional procedures. Patient awareness during routine use of HFJV has not been evaluated in this setting. A Bispectral index (Bis) value of less than 60 is generally accepted as appropriate level of sedation during general anesthesia. Methods: Seventy two consecutive patients underwent EP studies including ablation for supraventricular and ventricular arrhythmias (n=74) in an invasive EP laboratory using HFJV. Any EP studies where ablation was attempted were included for analysis. Patients underwent induction of general anesthesia with endotracheal intubation using inhaled positive pressure ventilation with sevoflurane in the EP laboratory prior to vascular access. HFJV was then provided by a commercial system with initial settings: ventilation rate at 100 cycles per minute and drive pressure at 20-25psi. Total intravenous anesthesia was then provided with dexmedetomidine and propofol as well as fentanyl and rocuronium titrated to Bis score. Results: The overall mean age of patients was 55±18 years (range=18-84years) and the overall mean Bis score was 40±5.3 (see Poster). No patient experienced awareness during the procedure. Conclusions: This first report of patient tolerance using high frequency jet ventilation in an invasive electrophysiology laboratory demonstrates that HFJV is well tolerated by patients with an average Bis score of 40±5.3 and no patient experienced procedural awareness.

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High-frequency jet ventilation (HFJV) is used to decrease respiratory motion during atrial fibrillation ablations; however, the patient safety and efficacy of HFJV has not been evaluated during routine electrophysiology (EP) studies with radiofrequency ablation. This is a retrospective chart review of consecutive patients who underwent EP studies and ablations for supraventricular and ventricular arrhythmias while using HFJV. Any EP studies performed using HFJV where ablation was attempted were included for analysis; EP studies where no ablation was performed were not included. Patients underwent induction of general anesthesia with endotracheal intubation using intermittent positive pressure ventilation with sevoflurane in the EP laboratory prior to vascular access. HFJV was then provided by a commercial system with initial settings: ventilation rate at 100 cycles/min and driving pressure at 20–25 psi. Total intravenous anesthesia was then provided with dexmedetomidine and propofol as well as fentanyl and rocuronium titrated to bispectral index (Bis) score <60. The overall mean age of patients (n=72) was 55+/-18 years (ranges 18–84 years). The mean creatinine (mg/dl) was 1.0+/-0.3, the mean ejection was 0.58+/-0.08, and mean post-EP study length of stay was 1.4+/-0.9 days (range 1–5 days). There were no intraprocedural or major complications. There was a 6.9% rate of minor complications (n=5). There was a 97.2% overall ablation success rate (70 of 72 ablations). Ablations were successful in all subjects except for one left atrial flutter and one right atrial tachycardia. Only one of 72 (1.4%) procedures required discontinuation of general anesthesia and HFJV to induce arrhythmia (right ventricular outflow tract ventricular tachycardia). No patient experienced procedural awareness and the mean Bis score was 40+/-5.3. This report provides further evidence the routine use of jet ventilation in the electrophysiology laboratory is safe, well tolerated, and efficacious, with ablation success rates similar to traditional sedation/ventilation techniques with a variety of arrhythmias.

For Full Study Please See:  http://www.innovationsincrm.com/cardiac-rhythm-management/2011/november/157-high-frequency-jet-ventilation