Circulation. Arrhythmia and electrophysiology · 2026
Ventricular Fibrillation Mapping in a Large-Animal Model Using Dual Mechanical Circulatory Support: Electroanatomic Substrate Preservation Without Ischemic Changes.
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Quelal Analuisa Karol, Tri Jason A, Haq Ikram U, Welle Amalia, Niu Hanxu, Behfar Atta, Yalamuri Suraj, Ward Robert, Ezzedine Fatima, Talkachova Elena, Tan Nicholas Y, Del-Carpio Munoz Freddy, Asirvatham Samuel, DeSimone Christopher V
Аннотация
BACKGROUND: Ventricular fibrillation (VF) remains a leading cause of sudden cardiac death with an incompletely characterized electrophysiological substrate. Traditional large-animal VF models are limited by hemodynamic collapse and myocardial ischemia. This study establishes a reproducible swine model using dual mechanical circulatory devices to enable high-density electroanatomic mapping under nonischemic conditions.
METHODS: Five Yorkshire swine (55-65 kg) underwent sustained VF supported by venoarterial extracorporeal membrane oxygenation (2.5-3.0 L/min) and percutaneous left ventricular unloading (Impella CP, P-2-P-4). High-density electroanatomic mapping using CARTO 7 was performed at baseline and after defibrillation. Bipolar voltage was acquired from 7 predefined ventricular regions (21 measurements per animal per time point; n=210 paired observations). Unipolar voltage mapping and continuous surface ECG monitoring were used to assess acute ischemic injury. Systemic perfusion was maintained at systolic arterial pressure ≥80 mm Hg. Linear mixed-effects modeling was used to analyze voltage changes from pre-VF to post-VF.
RESULTS: Sustained VF (10±1 minutes) was reproducibly induced and maintained with consistent hemodynamics (systolic arterial pressure, 90±5 mm Hg; extracorporeal membrane oxygenation flow, 2.5±0.5 L/min). All animals were successfully defibrillated. High-density mapping was feasible in all experiments (1000±300 points per chamber). Bipolar voltage showed no change from pre-VF (5.86±2.56 mV) to post-VF (6.53±2.22 mV; mean difference, 0.67 mV [95% CI, -0.31 to 1.65]; P=0.15). Both left (P=0.17) and right ventricles (P=0.08) demonstrated voltage preservation. Regional analysis showed no significant changes (all P>0.05); post-VF voltages remained above viability thresholds (>1.5 mV). Unipolar voltage maps recovered toward baseline, with no ECG injury pattern identified after defibrillation.
CONCLUSIONS: Dual mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and Impella CP enables reproducible, high-fidelity electroanatomic mapping and preserves myocardial substrate after sustained VF in a large-animal model. This platform overcomes key technical barriers in VF research, providing a nonischemic foundation for future mechanistic and translational studies.
METHODS: Five Yorkshire swine (55-65 kg) underwent sustained VF supported by venoarterial extracorporeal membrane oxygenation (2.5-3.0 L/min) and percutaneous left ventricular unloading (Impella CP, P-2-P-4). High-density electroanatomic mapping using CARTO 7 was performed at baseline and after defibrillation. Bipolar voltage was acquired from 7 predefined ventricular regions (21 measurements per animal per time point; n=210 paired observations). Unipolar voltage mapping and continuous surface ECG monitoring were used to assess acute ischemic injury. Systemic perfusion was maintained at systolic arterial pressure ≥80 mm Hg. Linear mixed-effects modeling was used to analyze voltage changes from pre-VF to post-VF.
RESULTS: Sustained VF (10±1 minutes) was reproducibly induced and maintained with consistent hemodynamics (systolic arterial pressure, 90±5 mm Hg; extracorporeal membrane oxygenation flow, 2.5±0.5 L/min). All animals were successfully defibrillated. High-density mapping was feasible in all experiments (1000±300 points per chamber). Bipolar voltage showed no change from pre-VF (5.86±2.56 mV) to post-VF (6.53±2.22 mV; mean difference, 0.67 mV [95% CI, -0.31 to 1.65]; P=0.15). Both left (P=0.17) and right ventricles (P=0.08) demonstrated voltage preservation. Regional analysis showed no significant changes (all P>0.05); post-VF voltages remained above viability thresholds (>1.5 mV). Unipolar voltage maps recovered toward baseline, with no ECG injury pattern identified after defibrillation.
CONCLUSIONS: Dual mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and Impella CP enables reproducible, high-fidelity electroanatomic mapping and preserves myocardial substrate after sustained VF in a large-animal model. This platform overcomes key technical barriers in VF research, providing a nonischemic foundation for future mechanistic and translational studies.