{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T12:03:37Z","timestamp":1785240217258,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In catheter ablation of atrial fibrillation (AF), durable lesion formation is essential for successful pulmonary vein isolation (PVI). Force\u2013time integral (FTI) is an established lesion metric that reflects the cumulative effect of contact force (CF) and radiofrequency (RF) application time and has been associated with lesion durability. Although high\u2010frequency low\u2013tidal volume ventilation (HFLTVV) has been associated with improved procedural outcomes, lesion\u2010level evidence in the era of contact force\u2010guided ablation remains limited. We aimed to evaluate the association between HFLTVV and lesion metrics during PVI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      This single\u2010center retrospective study included patients with paroxysmal AF undergoing first\u2010time RF PVI. Procedures were performed during the standard ventilation (SV) and the HFLTVV eras, with CF targeted at 10\u201312\u00a0g. Lesion parameters, including RF application time, average CF, ablation index (AI), FTI, and impedance drop, were extracted from CARTONET and analyzed overall and by pulmonary vein region. Respiratory effects were assessed using arterial blood gas analysis. Compared with SV, HFLTVV was associated with significantly higher FTI and AI (FTI: 268.8 \u00b1 31.5\u00a0vs 235.2 \u00b1 21.7 g\u00b7s; AI: 459.0 \u00b1 16.8\u00a0vs 437.1 \u00b1 13.4; both\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001), despite similar CF and RF application time. Findings were consistent across pulmonary vein regions. In multivariable analyses adjusting for baseline characteristics, HFLTVV remained independently associated with higher FTI and AI (both\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). Procedural duration and arrhythmia recurrence were similar between groups. Arterial blood gas analysis demonstrated no clinically significant CO\n                      <jats:sub>2<\/jats:sub>\n                      retention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HFLTVV was associated with higher FTI and AI under comparable CF and RF application time. These findings suggest that HFLTVV may influence lesion metrics during AF ablation and warrant further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70380","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:25:51Z","timestamp":1785237951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of HFLTVV With Force\u2010Time Integral and Ablation Index During Pulmonary Vein Isolation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3331-1954","authenticated-orcid":false,"given":"Tatsuya","family":"Shigematsu","sequence":"first","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimikazu","family":"Banba","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7921-9428","authenticated-orcid":false,"given":"Masato","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Moriya","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natsuki","family":"Kanazawa","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1271-3086","authenticated-orcid":false,"given":"Motomi","family":"Tachibana","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5993-130X","authenticated-orcid":false,"given":"Yutaka","family":"Take","sequence":"additional","affiliation":[{"name":"Departments of Cardiology Sakakibara Heart Institute of Okayama  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"973","article-title":"Impact of High\u2010Power Short\u2010Duration Radiofrequency Ablation on Long\u2010Term Lesion Durability for Atrial Fibrillation Ablation","volume":"6","author":"Yavin H. D.","year":"2020","journal-title":"Journal of the American College of Cardiology: Clinical Electrophysiology"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1111\/j.1540-8167.2010.01750.x","article-title":"Area Under the Real\u2010Time Contact Force Curve (Force\u2010Time Integral) Predicts Radiofrequency Lesion Size in an in Vitro Contractile Model","volume":"21","author":"Shah D. C.","year":"2010","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1093\/europace\/euu068","article-title":"Contact Force and Force\u2010Time Integral in Atrial Radiofrequency Ablation Predict Transmurality of Lesions","volume":"16","author":"Squara F.","year":"2014","journal-title":"Europace"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.hrthm.2010.10.043","article-title":"General Anesthesia Reduces the Prevalence of Pulmonary Vein Reconnection During Repeat Ablation When Compared With Conscious Sedation: Result From a Randomized Study","volume":"8","author":"Di Biase L.","year":"2011","journal-title":"Heart Rhythm"},{"key":"e_1_2_8_6_1","first-page":"1543","article-title":"High\u2010Frequency Low\u2010Tidal Volume Ventilation Improves Long\u2010Term Outcomes in AF Ablation: A Multicenter Prospective Study","volume":"9","author":"Osorio J.","year":"2023","journal-title":"Journal of the American College of Cardiology: Clinical Electrophysiology"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"1962","DOI":"10.1111\/jce.16393","article-title":"Lesion Characteristics Using High\u2010frequency Low\u2010Tidal Volume Ventilation Versus Standard Ventilation During Ablation of Paroxysmal Atrial Fibrillation","volume":"35","author":"Qian X.","year":"2024","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1093\/europace\/euv057","article-title":"EFFICAS II: Optimization of Catheter Contact Force Improves Outcome of Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation","volume":"17","author":"Kautzner J.","year":"2015","journal-title":"Europace"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1161\/CIRCULATIONAHA.114.014092","article-title":"Randomized, Controlled Trial of the Safety and Effectiveness of a Contact Force\u2013Sensing Irrigated Catheter for Ablation of Paroxysmal Atrial Fibrillation: Results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR)","volume":"132","author":"Reddy V. Y.","year":"2015","journal-title":"Circulation"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.hrthm.2015.08.010","article-title":"Contact Force Threshold for Permanent Lesion Formation in Atrial Fibrillation Ablation: A Cardiac Magnetic Resonance\u2013based Study to Detect Ablation Gaps","volume":"13","author":"Andreu D.","year":"2016","journal-title":"Heart Rhythm"},{"key":"e_1_2_8_11_1","first-page":"163","article-title":"Initiation of High\u2010frequency jet Ventilation for Catheter Ablation of Atrial Fibrillation","volume":"4","author":"Sivasambu B.","year":"2018","journal-title":"Journal of the American College of Cardiology: Clinical Electrophysiology"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2022.937913","article-title":"Tailored Target Ablation Index\u2013Guided Pulmonary Vein Isolation in Treating Paroxysmal Atrial Fibrillation: A Single\u2010Center Randomized Study in Asian Population (AI\u2010Asian\u2010I)","volume":"9","author":"Xiong Q.","year":"2022","journal-title":"Frontiers in Cardiovascular Medicine"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s00380-017-0961-z","article-title":"General Anesthesia Improves Contact Force and Reduces Gap Formation in Pulmonary Vein Isolation: A Comparison With Conscious Sedation","volume":"32","author":"Chikata A.","year":"2017","journal-title":"Heart and Vessels"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.hrthm.2012.02.015","article-title":"Effect of Respiration on Catheter\u2010Tissue Contact Force During Ablation of Atrial Arrhythmias","volume":"9","author":"Kumar S.","year":"2012","journal-title":"Heart Rhythm"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70380","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70380","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:25:54Z","timestamp":1785237954000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":13,"alternative-id":["10.1111\/pace.70380"],"URL":"https:\/\/doi.org\/10.1111\/pace.70380","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"2026-06-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70380"}}