• Wyffels Piet A H PAH Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: piet.wyffels@ugent.be., De Hert Stefan S Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium; Department of Basic and Applied Sciences, Ghent Univ, and Patrick F Wouters.
• Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: piet.wyffels@ugent.be.
• Br J Anaesth. 2021 Jan 1; 126 (1): 111-119.

BackgroundTraditional formulas to calculate pulse pressure variation (PPV) cannot be used in patients with atrial fibrillation (AF). We have developed a new algorithm that accounts for arrhythmia-induced pulse pressure changes, allowing us to isolate and quantify ventilation-induced pulse pressure variation (VPPV). The robustness of the algorithm was tested in patients subjected to altered loading conditions. We investigated whether changes in VPPV imposed by passive leg raising (PLR) were proportional to the pre-PLR values.MethodsConsenting patients with active AF scheduled for an ablation of the pulmonary vein under general anaesthesia and mechanical ventilation were included. Loading conditions were altered by PLR. ECG and invasive pressure data were acquired during 60 s periods before and after PLR. A generalised additive model was constructed for each patient on each observation period. The impact of AF was modelled on the two preceding RR intervals of each beat (RR0 and RR-1). The impact of ventilation and the long-term pulse pressure trends were modelled as separate splines. Ventilation-induced pulse pressure variation was defined as the percentage of the maximal change in pulse pressure during the ventilation cycle.ResultsNine patients were studied. The predictive abilities of the models had a median r2 of 0.92 (inter-quartile range: 89.2-94.2). Pre-PLR VPPV ranged from 0.1% to 27.9%. After PLR, VPPV decreased to 0-11.3% (P<0.014). The relation between the Pre-PLR values and the magnitude of the changes imposed by the PLR was statistically significant (P<0.001).ConclusionsOur algorithm enables quantification of VPPV in patients with AF with the ability to detect changing loading conditions.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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