First catheter‐based high‐density endocardial 3D electroanatomical mapping of the right atrium in standing horses

BACKGROUND: Three‐dimensional electroanatomical mapping is of potential interest in equine cardiology to identify arrhythmia mechanisms, characterise electroanatomical substrates and guide ablation strategies. OBJECTIVES: To describe three‐dimensional electroanatomical mapping in standing horses. STUDY DESIGN: Research methodology, proof of concept study. METHODS: Four Standardbred horses (2 geldings, 2 mares, median age 4.5 [4‐9] years, mean bodyweight 485 [440‐550] kg) were sedated and placed in stocks. Via the jugular vein, a high‐density multipolar grid catheter (Advisor(™) HD Grid Mapping Catheter with EnSite VelocityTM, Abbott Medical) was used for endocardial mapping of the right atrium. The P‐wave on the surface ECG was used as a timing reference for simultaneous local activation time‐ and bipolar voltage‐mapping. For a positional reference a 10‐pole catheter (Abbott Medical) was placed in the caudal vena cava. RESULTS: Endocardial right atrial mapping guided by the three‐dimensional mapping system and local electrograms was successfully performed in all four horses. A median of 32719 [25499‐65078] points, covering the entire right atrium, were collected. Three‐dimensional electroanatomical mapping provided detailed information about activation patterns and electrogram‐characteristics of the sinoatrial node, intervenous tubercle and cavotricuspid isthmus. Additionally, transvenous biopsy forceps connected to the mapping system were visualised on screen to guide biopsy collection. MAIN LIMITATIONS: The feasibility of electroanatomical mapping for the left atrium and in larger breeds requires further study. CONCLUSIONS: High‐density three‐dimensional electroanatomical mapping of the right atrium is feasible in the standing horse.