Background:Sedation during pulmonary vein isolation (PVI) for atrial fibrillation often provokes a decline in left atrial (LA) pressure (LAP) under atmospheric pressure and increases the risk of systemic air embolisms. This study aimed to investigate the efficacy of adaptive servo-ventilation (ASV) on the LAP in sedated patients.

Methods and Results:Fifty-one consecutive patients undergoing cryoballoon PVI were enrolled. All patients underwent sedation using propofol throughout the procedure. After the transseptal puncture and the insertion of a long sheath into the LA, the LAP was measured. Then, the ASV treatment was started, and the LAP was re-measured. The LAP before and after the ASV support was investigated. Before ASV, the LAP during the inspiratory phase was significantly smaller than that during the expiratory phase (4.9±5.4 mmHg vs. 14.0±5.2 mmHg, P<0.01). The lowest LAP was −2.2±5.1 mmHg and was under 0 mmHg in 37 (73%) patients. After the ASV, the LAP during the inspiratory phase significantly increased to 8.9±4.1 mmHg (P<0.01), and lowest LAP increased to 4.7±5.9 mmHg (P<0.01). The negative lowest LAP value became positive in 30/37 (81%) patients. There were no statistical differences regarding obstructive sleep apnea (OSA), obesity, gender, or other comorbidities between patients with and without a negative lowest LAP after ASV support.

Conclusions:ASV is effective for increasing the LAP above 0 mmHg and might prevent air embolisms during PVI.

背景：心房颤动肺静脉隔离 (PVI) 期间的镇静通常会导致大气压下左心房 (LA) 压力 (LAP) 下降，并增加全身空气栓塞的风险。本研究旨在探讨适应性伺服通气 (ASV) 对镇静患者 LAP 的疗效。

方法和结果：招募了 51 名连续接受冷冻球囊 PVI 的患者。所有患者在整个手术过程中均使用丙泊酚进行镇静。在经间隔穿刺和将长鞘插入 LA 后，测量 LAP。然后，开始 ASV 治疗，并重新测量 LAP。调查了 ASV 支持前后的 LAP。在 ASV 之前，吸气相 LAP 显着小于呼气相（4.9±5.4 mmHg vs. 14.0±5.2 mmHg，P<0.01）。37 名 (73%) 患者的最低 LAP 为 -2.2±5.1 mmHg，低于 0 mmHg。ASV后，吸气相LAP显着升高至8.9±4.1 mmHg（P<0.01），最低LAP升高至4.7±5.9 mmHg（P<0.01）。30/37 (81%) 患者的负最低 LAP 值变为正值。

结论： ASV 可有效地将 LAP 提高到 0 mmHg 以上，并可能预防 PVI 期间的空气栓塞。