TY - JOUR
T1 - 3D-electroanatomical mapping of the left atrium and catheter-based pulmonary vein isolation in pigs
T2 - A practical guide
AU - Hertel, Julie Norup
AU - Jerltorp, Kezia
AU - Hansen, Malthe Emil Høtbjerg
AU - Isaksen, Jonas L
AU - Sattler, Stefan Michael
AU - Linz, Benedikt
AU - Chaldoupi, Sevasti-Maria
AU - Jespersen, Thomas
AU - Saljic, Arnela
AU - Gang, Uffe
AU - Manninger, Martin
AU - Linz, Dominik
N1 - Copyright © 2023 Hertel, Jerltorp, Hansen, Isaksen, Sattler, Linz, Chaldoupi, Jespersen, Saljic, Gang, Manninger and Linz.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
U2 - 10.3389/fcvm.2023.1139364
DO - 10.3389/fcvm.2023.1139364
M3 - Article
C2 - 36970354
SN - 2297-055X
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1139364
ER -