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A Guide to the Porcine Anatomy for the Interventional Electrophysiologist. Fluoroscopy and High Density Electroanatomical Mapping

  • Sebastian HilbertEmail author
  • Jedrzej Kosiuk
  • Silke John
  • Gerhard Hindricks
  • Andreas Bollmann
Article

Abstract

Invasive electrophysiology is a rapidly developing field of cardiovascular science with a constant need for inventions and testing of new technologies and concepts. Despite the swine model being an established tool in biomedical research no comprehensive guide for interventional electrophysiologists exists. The aim of the current article is to provide a practical overview of the pig anatomy, fluoroscopic views, and corresponding high density electroanatomic maps using a novel mapping system and a practical guide for interventions and techniques. In 17 pigs, fluoroscopic images of the right atrium, coronary sinus (CS), left atrium, and pulmonary veins as well as the right and left ventricles were obtained and correlated with ultra-high density electroanatomic maps and gross anatomy. Pitfalls of the porcine anatomy are precisely addressed, and alternative access techniques to overcome those issues are suggested. Important differences to human electrophysiological studies are highlighted. Complementary models such as cardiac ischemia induction or renal and pulmonary artery denervation are discussed in detail.

Keywords

Porcine model Cardiac anatomy Ultra-high density mapping 

Notes

Acknowledgments

The authors would like to thank Sebastian Weickert, Susanne Ossmann, Sarah Klein, Heart Center Leipzig, and Roberto Bavila and Steve Mure, Boston Scientific for their support of this project.

Conflict of Interest

This study has been supported by an unrestricted Boston Scientific grant to the Heart Center Leipzig. Drs. Bollmann and Kosiuk have received moderate consulting and lecture fees from Boston Scientific.

Supplementary material

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Online Resource 1 Porcine heart. a) Heart in situ. Excised heart in an anterior-posterior (b) view, right lateral view (c) and left lateral view (d). Observe the prominent right atrial appendage in panel a. The grey sheath depicted in panels b-d is placed along the path from IVC to SVC. Panel d exhibits a strictly posterior facing aorta with its short and sharply angled aortic arch (see also Fig. 4). (PNG 7977 kb)
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Online Resource 2 Angiography of the coronary sinus. In the LAO projection (a) Observe the proximal vestibulum and distal CS and the marked jump in size between the two structures which is found in 50 % of the pigs our series. Panel b (LAO projection) features the prominent left azygos vein often present in the pig heart. (PNG 279 kb)
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Online Resource 3 Epicardial access obtained by subxypoid puncture. Observe the RAO projection of the sheath in a) the posterior epicardial space and anterior pericardial space (b). Correct placement is confirmed by appreciating contrast in the pericardial space (c). Panel d visualizes the setup for simultaneous mapping of the RA with the endocardial placement of the basket catheter (IntellaMap Orion ™, Boston Scientific) and the epicardial placement of the ablation catheter (IntellaTip MiFi, Boston Scientific). (PNG 964 kb)
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Online Resource 4 Anterior view on the activation map of the right atrium obtained by a) epicardial mapping and b) endocardial mapping. Observe that the area of earliest activation in both maps matches perfectly. (PNG 599 kb)
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Online Resource 5 Transapical approach: a) RAO view of the porcine heart. Puncture needle is visible in the left ventricle as well as a cloud of contrast injected for guiding needled placement. b) guidewire inserted through the needle and placed in the aorta for final placement of a sheath. c) left lateral view on the porcine thoracic cavity. Observe the sheath which has been inserted into the left ventricular apex by subxyphoid puncture. d) Angiography of the left atrium in left anterior oblique projection. A sheath has been placed through the left ventricular apex and mitral valve. (PNG 1714 kb)
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Online Resource 6 Right atrial appendage (RAA) and epicardial access via RAA puncture. Angiography of the RAA and RA in an anterior posterior projection (a). Observe the mapping catheter in the pericardial space which has been advanced through the RAA. (PNG 319 kb)
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Online Resource 7 Angiography of the coronary arteries in an LAO view. Observe the dominant right coronary artery (RCA) (a) and the left anterior descending artery as well as circumflex artery (b). The sinus node artery is a branch of the RCA. Catheters are placed in the coronary sinus (CS) and retrogradly in the left ventricle (LV). Balloon occlusion of the LAD can be observed in panel c. (PNG 1040 kb)
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Online Resource 8 Renal arteries: AP-view of the right renal arteries. Branching is similar to human anatomy (a). An ablation catheter is placed just before the first bifurcation for renal denervation (b). Renal artery spasm was oberserved after ablation (c) as well as the typical denervation notching and recovery from spasm following application of intravenous nitroglycerin (d). (PNG 1234 kb)
Online Resource 9

Left atrium (LA) and right atrium (RA): a) posterior view on the LA and RA, b) anterior view on the RA and LA. The mapping catheter is placed in the RA. The right and left ventricles have been cut out based on electrical signals. (MP4 2309 kb)

Online Resource 10

Anterior view on the activation map of the right atrium obtained by a) epicardial mapping and b) endocardial mapping. Observe that the area of earliest activation in both maps matches perfectly. (MP4 7415 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sebastian Hilbert
    • 1
    Email author
  • Jedrzej Kosiuk
    • 1
  • Silke John
    • 1
  • Gerhard Hindricks
    • 1
  • Andreas Bollmann
    • 1
  1. 1.Department of ElectrophysiologyHeart Center LeipzigLeipzigGermany

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