3D-electroanatomical mapping of the left atrium and catheter-based pulmonary vein isolation in pigs: A practical guide

Julie Norup Hertel; Kezia Jerltorp; Malthe Emil Høtbjerg Hansen; Jonas L Isaksen; Stefan Michael Sattler; Benedikt Linz; Sevasti-Maria Chaldoupi; Thomas Jespersen; Arnela Saljic; Uffe Gang; Martin Manninger; Dominik Linz

doi:10.3389/fcvm.2023.1139364

3D-electroanatomical mapping of the left atrium and catheter-based pulmonary vein isolation in pigs: A practical guide

Front Cardiovasc Med. 2023 Mar 9:10:1139364. doi: 10.3389/fcvm.2023.1139364. eCollection 2023.

Authors

Julie Norup Hertel¹, Kezia Jerltorp¹, Malthe Emil Høtbjerg Hansen¹, Jonas L Isaksen¹, Stefan Michael Sattler^{1

2}, Benedikt Linz^{1

3}, Sevasti-Maria Chaldoupi⁴, Thomas Jespersen¹, Arnela Saljic^{1

5}, Uffe Gang⁶, Martin Manninger^{4

7}, Dominik Linz^{1

4

6

8}

Affiliations

¹ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
² Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
³ Emergency Department, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark.
⁴ Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands.
⁵ West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany.
⁶ Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark.
⁷ Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
⁸ Centre for Heart Rhythm Disorders, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.

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.

Keywords: multielectrode mapping; pig; pulmonary vein ablation/isolation; radiofrequency ablation; transseptal puncture.