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Hertel JN, Jerltorp K, Hansen MEH, Isaksen JL, Sattler SM, Linz B, Chaldoupi SM, Jespersen T, Saljic A, Gang U, Manninger M, Linz D. 3D-electroanatomical mapping of the left atrium and catheter-based pulmonary vein isolation in pigs: A practical guide. Front Cardiovasc Med 2023; 10:1139364. [PMID: 36970354 PMCID: PMC10033609 DOI: 10.3389/fcvm.2023.1139364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Aim To propose a standardized workflow for 3D-electroanatomical mapping guided pulmonary vein isolation in pigs. Materials and methods Danish female landrace pigs were anaesthetized. Ultrasound-guided puncture of both femoral veins was performed and arterial access for blood pressure measurement established. Fluoroscopy- and intracardiac ultrasound-guided passage of the patent foramen ovale or transseptal puncture was performed. Then, 3D-electroanatomical mapping of the left atrium was conducted using a high-density mapping catheter. After mapping all pulmonary veins, an irrigated radiofrequency ablation catheter was used to perform ostial ablation to achieve electrical pulmonary vein isolation. Entrance- and exit-block were confirmed and re-assessed after a 20-min waiting period. Lastly, animals were sacrificed to perform left atrial anatomical gross examination. Results We present data from 11 consecutive pigs undergoing pulmonary vein isolation. Passage of the fossa ovalis or transseptal puncture was uneventful and successful in all animals. Within the inferior pulmonary trunk 2-4 individual veins as well as 1-2 additional left and right pulmonary veins could be cannulated. Electrical isolation by point-by-point ablation of all targeted veins was successful. However, pitfalls including phrenic nerve capture during ablation, ventricular arrhythmias during antral isolation close to the mitral valve annulus and difficulties in accessing right pulmonary veins were encountered. Conclusion Fluoroscopy- and intracardiac ultrasound-guided transseptal puncture, high-density electroanatomical mapping of all pulmonary veins and complete electrical pulmonary vein isolation can be achieved reproducibly and safely in pigs when using current technologies and a step-by-step approach.
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Affiliation(s)
- Julie Norup Hertel
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kezia Jerltorp
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Malthe Emil Høtbjerg Hansen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas L. Isaksen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Michael Sattler
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Benedikt Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arnela Saljic
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
| | - Uffe Gang
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Martin Manninger
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Dominik Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Dominik Linz,
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Vandecasteele T, Van Den Broeck W, Tay H, Couck L, van Loon G, Cornillie P. 3D reconstruction of the porcine and equine pulmonary veins, supplemented with the identification of telocytes in the horse. Anat Histol Embryol 2018; 47:145-152. [DOI: 10.1111/ahe.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 01/22/2023]
Affiliation(s)
- T. Vandecasteele
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - W. Van Den Broeck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - H. Tay
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - L. Couck
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - P. Cornillie
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
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