Hertel Julie Norup, Jerltorp Kezia, Hansen Malthe Emil Høtbjerg, Isaksen Jonas L, Sattler Stefan Michael, Linz Benedikt, Chaldoupi Sevasti-Maria, Jespersen Thomas, Saljic Arnela, Gang Uffe, Manninger Martin, Linz Dominik
Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Front Cardiovasc Med. 2023 Mar 9;10:1139364. doi: 10.3389/fcvm.2023.1139364. eCollection 2023.
To propose a standardized workflow for 3D-electroanatomical mapping guided pulmonary vein isolation in pigs.
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.
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.
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.
提出一种用于猪三维电解剖标测引导下肺静脉隔离的标准化工作流程。
对丹麦雌性长白猪进行麻醉。在超声引导下穿刺双侧股静脉，并建立用于测量血压的动脉通路。在透视和心腔内超声引导下经卵圆孔未闭或经房间隔穿刺。然后，使用高密度标测导管对左心房进行三维电解剖标测。在对所有肺静脉进行标测后，使用灌注射频消融导管进行开口处消融以实现肺静脉电隔离。确认入口和出口阻滞，并在20分钟等待期后重新评估。最后，处死动物以进行左心房大体解剖检查。
我们展示了11只连续接受肺静脉隔离的猪的数据。所有动物的卵圆窝通过或经房间隔穿刺均顺利成功。在下肺干内可插入2 - 4条独立静脉以及1 - 2条额外的左右肺静脉。通过逐点消融所有目标静脉实现电隔离成功。然而，遇到了一些问题，包括消融过程中捕获膈神经、在靠近二尖瓣环的窦部隔离期间出现室性心律失常以及进入右肺静脉困难。
使用当前技术和逐步方法，在猪中可以可重复且安全地实现透视和心腔内超声引导下的经房间隔穿刺、所有肺静脉的高密度电解剖标测以及完全的肺静脉电隔离。
