J. Pers. Med. 2023, 13, 186. https://doi.org/10.3390/jpm13020186 www.mdpi.com/journal/jpm Communication Jet Ventilation Reduces Coronary Sinus Movement in Patients Undergoing Atrial Fibrillation Ablation: An Observational Crossover Study Cécile Maeyens 1, *, Pierre Nokerman 1 , Ruben Casado-Arroyo 2 , Juan-Pablo Abugattas De Torres 2 , Brenton Alexander 3 , Edgard Engelman 4 , Denis Schmartz 1 and Turgay Tuna 1 1 Department of Anesthesiology, H.U.B.—Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium 2 Department of Cardiology, H.U.B.—Hôpital Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium 3 School of Medicine, University of California, La Jolla, San Diego, CA 92093, USA 4 EW Data Analysis, 1180 Brussels, Belgium * Correspondence: cecile.maeyens@hubruxelles.be Abstract: Background: One of the reasons that high-frequency jet ventilation (HFJV) is used is due to the near immobility of thoracic structures. However, no study has quantified the movements of cardiac structures during HFJV compared with normal mechanical ventilation. Methods: After eth- ical approval and written informed consent, we included 21 patients scheduled for atrial fibrillation ablation in this prospective crossover study. Each patient was ventilated with both normal mechan- ical ventilation and HFJV. During each ventilation mode, displacements of the cardiac structure were measured by the EnSite Precision mapping system using a catheter placed in the coronary sinus. Results: The median [Q1–Q4] displacement was 2.0 [0.6–2.8] mm during HFJV and 10.5 [9.3– 13.0] mm during conventional ventilation (p < 0.000001). Conclusion: This study quantifies the min- imal movement of cardiac structures during HFJV compared to standard mechanical ventilation. Keywords: high-frequency jet ventilation; intermittent positive pressure ventilation; atrial fibrillation ablation 1. Introduction With a worldwide prevalence of 43.6 million in 2016, atrial fibrillation (AFib) is an increasingly frequent pathology that also creates a significant impact on healthcare costs [1–3]. The catheter ablation procedure for the treatment of AFib was first introduced dur- ing the 1990s, and when compared with treatment using antiarrhythmic drugs, it im- proves quality of life by better restoring sinus rhythm [4,5] with a lower recurrence rate [6]. While initially these ablation procedures were performed under conscious sedation, they are now most often performed under general anesthesia [5]. This approach allows for a comfortable and motionless patient [7,8] throughout a potentially long procedure. General anesthesia has been shown to be associated with better stability of the ablation catheter, a better contact force with tissues, and shorter fluoroscopic and procedural times [8,9]. Unfortunately, the movement of the chest and its contents during mechanical venti- lation may interfere with the procedure. This has led to the use of high-frequency jet ven- tilation (HFJV) by some practitioners during ablation procedures [7,10]. The stability of the mapping and ablation catheter, linked to the near immobility of the thoracic structures during HFJV, allows a reduction in operating and fluoroscopic times, fewer recurrences and improves patient outcomes [7,8,11–14]. Citation: Maeyens, C.; Nokerman, P.; Casado-Arroyo, R.; Abugattas De Torres, J.-P.A.; Alexander, B.; Engelman, E.; Schmartz, D.; Tuna, T. Jet Ventilation Reduces Coronary Sinus Movement in Patients Undergoing Atrial Fibrillation Ablation: An Observational Crossover Study. J. Pers. Med. 2023, 13, 186. https://doi.org/10.3390/ jpm13020186 Academic Editor: Cyrus Motamed Received: 30 December 2022 Revised: 18 January 2023 Accepted: 18 January 2023 Published: 20 January 2023 Copyright: © 2023 by the authors. Li- censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and con- ditions of the Creative Commons At- tribution (CC BY) license (https://cre- ativecommons.org/licenses/by/4.0/).