Background: High-frequency low-tidal-volume (HFLTV) ventilation is a safe and cost-effective strategy that improves catheter stability, first-pass pulmonary vein isolation, and freedom from all-atrial arrhythmias during radiofrequency catheter ablation (RFCA) of paroxysmal and persistent atrial fibrillation (AF). However, the incremental value of adding rapid-atrial pacing (RAP) to HFLTV-ventilation has not yet been determined. Objective: To evaluate the effect of HFLTV-ventilation plus RAP during RFCA of paroxysmal AF on procedural and long-term clinical outcomes compared to HFLTV-ventilation alone. Methods: Patients from the REAL-AF prospective multicenter registry, who underwent RFCA of paroxysmal AF using either HFLTV+RAP (500-600 msec) or HFLTV ventilation alone from April 2020 to February 2023 were included. The primary outcome was freedom from all-atrial arrhythmias at 12-month follow-up. Secondary outcomes included procedural characteristics, long-term clinical outcomes, and procedure-related complications. Results: A total of 545 patients were included in the analysis (HFLTV+RAP=327 vs. HFLTV=218). There were no significant differences in baseline characteristics between the groups. No differences were observed in procedural (HFLTV+RAP 74 [57-98] vs. HFLTV 66 [53-85.75] min, p=0.617) and RF (HFLTV+RAP 15.15 [11.22-21.22] vs. HFLTV 13.99 [11.04-17.13] min, p=0.620) times. Both groups showed a similar freedom from all-atrial arrhythmias at 12-month follow-up (HFLTV+RAP 82.68% vs. HFLTV 86.52%, HR=1.43, 95% CI [0.94-2.16], p=0.093). There were no significant differences in freedom from AF-related symptoms (HFLTV+RAP 91.4% vs. HFLTV 93.1%, p=0.476) or AF-related hospitalizations (HFLTV+RAP 98.5% vs. HFLTV 97.2%, p=0.320). Procedure-related complications were low in both groups (HFLTV+RAP 0.6% vs. HFLTV 0%, p=0.247). Conclusion: In patients undergoing RFCA for paroxysmal AF, adding RAP to HFLTV-ventilation was not associated with improved procedural and long-term clinical outcomes.

Introduction: Capsulectomy is recommended in patients with cardiac implantable electronic device (CIED) infection after transvenous lead extraction (TLE) but is time-consuming and requires extensive tissue debridement. In this study, we describe the outcomes of chlorhexidine gluconate (CHG) scrubbing in lieu of capsulectomy for the treatment of CIED infections. Methods: This retrospective observational study included patients who underwent TLE for CIED-related infections. In the capsulectomy group, complete capsulectomy was performed after hardware removal. In the CHG group, thorough scrubbing of the generator pocket with 20 cc of 2% CHG followed by irrigation with approximately 500 cc of sterile normal saline (SNS) was performed. The primary outcomes included reinfection and hematoma formation in the generator pocket. Secondary outcomes included any adverse reaction to chlorhexidine, the need for reintervention, infection-related mortality, and total procedural time. Results: A total of 102 patients (mean age 67.2±13 years, 32.4% female) underwent CIED extraction with either total capsulectomy (n=54) or CHG (n=48) scrubbing. Hematoma formation was significantly higher in the capsulectomy group vs. the CHG group (13% vs. 0%, p=0.014), with no significant differences in the reinfection rate. Capsulectomy was associated with longer procedural time (133.7±78.5vs. 89.9±51.8 minutes, p=0.002). No adverse reactions to CHG were found. Four patients (4.3%) died from worsening sepsis: 3 in the capsulectomy group and 1 in the CHG group (p=0.346). Conclusions: In patients with CIED infections, the use of CHG without capsulectomy resulted in a lower risk of hematoma formation and shorter procedural times without an increased risk of reinfection or adverse events associated with CHG use.