Comparison of high frequency JET ventilation Versus conventional Intermittent Positive pressure ventilation on the effectiveness of catheter ablation for Atrial Fibrillation: a multicentre, double blinded, randomised controlled trial (JET-VIP AF)

Research Question: Is it beneficial for patients and the NHS for atrial fibrillation (AF) ablation to be conducted using high frequency jet ventilation (HFJV)? Background: AF affects 1.46 million people in the UK, with increasing prevalence due to aging and metabolic risk factors. AF treatment costs the NHS £2.5 billion annually. Selected cases are treated by pulmonary vein isolation (PVI), preventing ectopic beats that trigger AF. Single AF ablation success is 50-60% at 12 months, with failures due to non-durable lesions forming gaps in the PVI. Catheter stability critically impacts lesion quality. HFJV, using small, rapidly cycled tidal volumes, reduces respiratory motion of intracardiac catheters, improving stability. Retrospective, non-randomised studies suggest HFJV improves arrhythmia-free survival at 12 months (hazard ratio 0.32-0.41) compared to conventional intermittent positive pressure ventilation (IPPV). Our patient and public involvement group prioritises symptomatic benefit and reducing repeat procedures, due to their compound risk and inconvenience. Aims and Objectives: Establish HFJV’s clinical effectiveness during AF ablation in improving symptoms and reducing AF, while maintaining safety. Evaluate potential economic benefits to the NHS. Produce a high quality, patient-centred study with inclusive recruitment. Methods: A UK multicentre, double-blinded, randomised controlled trial with 1:1 allocation to HFJV or IPPV will be conducted. Power calculations suggest 316 patients are required (alpha=0.05, 1-beta=0.81-0.9, 6% crossover rate). Recruitment will occur from 11 tertiary arrhythmia clinics. Co-primary outcomes include symptom improvement (Atrial Fibrillation Effect on QualiTy-of-life [AFEQT] questionnaire) and freedom from atrial arrhythmia (>30sec) assessed via continuous watch monitor (PulseOn) at 12months. Secondary outcomes include major adverse cardiac and cerebral events (MACCE: composite of death, stroke, heart failure, myocardial infarction, or cardiac hospitalisation), freedom from arrhythmia >1hour, arrhythmia burden reduction, redo procedure listing, and antiarrhythmic drug re-initiation. Descriptive data will cover complications, anaesthesia satisfaction, procedure duration, catheter stability, healthcare resource use, and cardiac function changes. A within trial health economic evaluation will compare short-term implementation cost against downstream benefits of reduced redo procedures. Timelines for Delivery: Set-up, training, and equipment delivery will occur Dec 2025-July 2026. Recruitment begins with a pilot (July-Oct 2026) at 3 centres (Norwich, Oxford, Birmingham) randomising 32 patients. Enrolment rate, safety, and inclusion will be reviewed. Full recruitment (316 patients) extends Oct 2026-March 2028. Follow-up ends March 2029, with primary outcome analysis and dissemination by Sept 2029. Anticipated Impact and Dissemination: This study would be the first to provide high-quality evidence about the clinical efficacy of HFJV during AF ablation. A positive result would strongly advocate utilisation for patient benefit and support a European Society of Cardiology (ESC) class IB guideline recommendation. Health economic analysis will inform NICE evaluation on cost-effectiveness. A negative result would discourage unnecessary NHS expenditure on further HFJV implementation. Results will be presented internationally, published in a high-impact journal, and a lay summary shared with participants.