This work was supported by the German Centre for Cardiovascular Research (DZHK; 81X3600221to H.V., 81X2600255 to S.C.), the China Scholarship Council (CSC201808130158 to R.X.), the German Research Foundation (DFG; Clinician Scientist Program in Vascular Medicine (PRIME), MA 2186/14-1 to P. T.), and the Corona Foundation (S199/10079/2019 to S. C.).

Animal care and all experimental procedures were conducted following the guidelines of the Animal Care and Ethics Committee of the Ludwig-Maximilians-University of Munich, and all the procedures using mice were approved by the Regierung von Oberbayern (ROB 55.2-2532. Vet_02-20-215, ROB 55.2-2532. Vet_02-18-46, ROB 55.2-2532. Vet_02-19-86, ROB 55.2-2532. Vet_02-21-178, ROB 55.2-2532. Vet_02-22-170). C57BL6/N mice were commercially obtained.
1. Preparation
<ol>
	<li>Prepare a ...

Revealing Murine Pulmonary Veins Myocardial Architecture

<ol>
	<li>Lippi, G., Sanchis-Gomar, F., Cervellin, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Global+epidemiology+of+atrial+fibrillation:+An+increasing+epidemic+and+public+health+challenge.">Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge.</a> International Journal of Stroke. 16 (2), 217-221 (2021).</li><li>Wijesurendra, R. S., Casadei, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+atrial+fibrillation.">Mechanisms of atrial fibrillation.</a> Heart. 105 (24), 1860-1867 (2019).</li><li>Ha&#239;ssaguerre, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spontaneous+initiation+of+atrial+fibrillation+by+ectopic+beats+originating+in+the+pulmonary+veins.">Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.</a> The New England Journal of Medicine. 339 (10), 659-666 (1998).</li><li>Mueller-Hoecker, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Of+rodents+and+humans:+a+light+microscopic+and+ultrastructural+study+on+cardiomyocytes+in+pulmonary+veins.">Of rodents and humans: a light microscopic and ultrastructural study on cardiomyocytes in pulmonary veins.</a> International Journal of Medical Sciences. 5 (3), 152-158 (2008).</li><li>Kramer, A. W., Marks, L. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+occurrence+of+cardiac+muscle+in+the+pulmonary+veins+of+Rodenita.">The occurrence of cardiac muscle in the pulmonary veins of Rodenita.</a> Journal of Morphology. 117 (2), 135-149 (1965).</li><li>Nathan, H., Eliakim, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+junction+between+the+left+atrium+and+the+pulmonary+veins.">The junction between the left atrium and the pulmonary veins.</a> Circulation. 34 (3), 412-422 (1966).</li><li>Nathan, H., Gloobe, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Myocardial+atrio-venous+junctions+and+extensions+(sleeves)+over+the+pulmonary+and+caval+veins:+Anatomical+observations+in+various+mammals.">Myocardial atrio-venous junctions and extensions (sleeves) over the pulmonary and caval veins: Anatomical observations in various mammals.</a> Thorax. 25 (3), 317-324 (1970).</li><li>Bond, R. C., Choisy, S. C., Bryant, S. M., Hancox, J. C., James, A. 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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spread+of+excitation+from+the+atrium+into+thoracic+veins+in+human+beings+and+dogs.">Spread of excitation from the atrium into thoracic veins in human beings and dogs.</a> The American Journal of Cardiology. 30 (8), 844-854 (1972).</li><li>Scott McNutt, N., Weinstein, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Membrane+ultrastructure+at+mammalian+intercellular+junctions.">Membrane ultrastructure at mammalian intercellular junctions.</a> Progress in Biophysics and Molecular Biology. 26, 45-101 (1973).</li><li>Barr, L., Dewey, M. M., Berger, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Propagation+of+action+potentials+and+the+structure+of+the+nexus+in+cardiac+muscle.">Propagation of action potentials and the structure of the nexus in cardiac muscle.</a> Journal of General Physiology. 48 (5), 797-823 (1965).</li><li>Kawamura, K., Konishi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrastructure+of+the+cell+junction+of+heart+muscle+with+special+reference+to+its+functional+significance+in+excitation+conduction+and+to+the+concept+of+&amp;#34;disease+of+intercalated+disc&amp;#34.">Ultrastructure of the cell junction of heart muscle with special reference to its functional significance in excitation conduction and to the concept of &amp;#34;disease of intercalated disc&amp;#34.</a> Japanese Circulation Journal. 31 (11), 1533-1543 (1967).</li><li>Van Kempen, M. J., Fromaget, C., Gros, D., Moorman, A. F., Lamers, W. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatial+distribution+of+connexin43,+the+major+cardiac+gap+junction+protein,+in+the+developing+and+adult+rat+heart.">Spatial distribution of connexin43, the major cardiac gap junction protein, in the developing and adult rat heart.</a> Circulation Research. 68 (6), 1638-1651 (1991).</li><li>Verheule, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tissue+structure+and+connexin+expression+of+canine+pulmonary+veins.">Tissue structure and connexin expression of canine pulmonary veins.</a> Cardiovascular Research. 55 (4), 727-738 (2002).</li><li>Xiao, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expression+of+connexin+43,+ion+channels+and+Ca2+-handling+proteins+in+rat+pulmonary+vein+cardiomyocytes.">Expression of connexin 43, ion channels and Ca2+-handling proteins in rat pulmonary vein cardiomyocytes.</a> Experimental and Therapeutic Medicine. 12 (5), 3233-3241 (2016).</li><li>Xia, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Whole-mount+immunofluorescence+staining,+confocal+imaging+and+3D+reconstruction+of+the+sinoatrial+and+atrioventricular+node+in+the+mouse.">Whole-mount immunofluorescence staining, confocal imaging and 3D reconstruction of the sinoatrial and atrioventricular node in the mouse.</a> Journal of Visualized Experiments. (166), (2020).</li><li>Tomsits, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medetomidine/midazolam/fentanyl+narcosis+alters+cardiac+autonomic+tone+leading+to+conduction+disorders+and+arrhythmias+in+mice.">Medetomidine/midazolam/fentanyl narcosis alters cardiac autonomic tone leading to conduction disorders and arrhythmias in mice.</a> Lab Animal. 52 (4), 85-92 (2023).</li><li>Xia, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolation+and+culture+of+resident+cardiac+macrophages+from+the+murine+sinoatrial+and+atrioventricular+node.">Isolation and culture of resident cardiac macrophages from the murine sinoatrial and atrioventricular node.</a> Journal of Visualized Experiments. (171), (2021).</li><li>Bredeloux, P., Pasqualin, C., Bordy, R., Maupoil, V., Findlay, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Automatic+activity+arising+in+cardiac+muscle+sleeves+of+the+pulmonary+vein.">Automatic activity arising in cardiac muscle sleeves of the pulmonary vein.</a> Biomolecules. 12 (1), 23 (2021).</li><li>Chen, P. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mechanisms+of+atrial+fibrillation.">The mechanisms of atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 17, S2-S7 (2006).</li><li>Thibault, S., Ton, A. -. T., Huynh, F., Fiset, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Connexin+lateralization+contributes+to+male+susceptibility+to+atrial+fibrillation.">Connexin lateralization contributes to male susceptibility to atrial fibrillation.</a> International Journal of Molecular Sciences. 23 (18), 10696 (2022).</li></ol>

With this protocol, we share a method to distinguish and isolate the PVs of the mouse heart and perform immunofluorescence staining on them. After the organ harvest, the heart and lungs were dehydrated in sterilized sucrose solution, followed by separating the ventricles from the atrium and lung lobes under microscopic guidance. Afterwards, the heart base was prepared to visualize the PVs followed by cutting them from the lungs at the hilum. The subsequent immunofluorescence staining was performed using a cryotechnique b...

Atrial fibrillation (AF) is the most common sustained arrhythmia1. The prevalence of AF is increasing even further with an expected number of ~17.9 million patients in Europe in 20601. AF is clinically highly important since it is an essential risk factor for the development of myocardial infarction, heart failure, or stroke, resulting in an enormous individual, social, and socioeconomic burden1. Even though AF has been known for decades, the pathophysiology of AF is still not fully understood2.
Already in the late 1990s, studies demonstrated the great impact of pulmonary veins (PVs) in initiating and maintaining AF, as they are the main source of AF-triggering ectopic beats3. It has been demonstrated that PVs structurally differ from other blood vessels. While typical blood vessels contain smooth muscle cells, the tunica media of PVs also contains cardiomyocytes4. In rodents, this cardiac musculature is ubiquitously present throughout the whole PVs, including intra- and extrapulmonary parts, as well as the orifice region5. In humans, PVs also contain cardiomyocytes, which can be observed within extensions of the left atrial (LA) myocardium-so-called myocardial sleeves (MS)6,7.
MS have morphological similarities to the atrial myocardium8. The shape and size of atrial and PV cardiomyocytes do not vary significantly between each other and show comparable electrophysiological properties8. Electrophysiologic recordings within the PV have proven the electrical activity of MS, and angiographic imaging has revealed contractions synchronized with the heartbeat9,10.
Gap junctions are pore-forming protein complexes composed of six connexin subunits, which allow the passage of ions and small molecules11. Gap junctions exist in the cell-to-cell appositions, interconnect neighboring cardiomyocytes, and enable an intercellular electrical coupling between cardiomyocytes12,13. Several connexin isoforms are expressed in the heart with connexin 43 (Cx43) being the most common isoform expressed in all regions of the heart14. Previous studies provide evidence for the expression of Cx43 in cardiomyocytes of the PVs15,16.
It remains challenging to investigate MS within intact PVs due to their delicate structure, especially in small animal models. Here, we demonstrate how to identify and isolate PVs together with LA and lung lobes in mice using microscopy-guided microdissection. Additionally, we demonstrate immunofluorescence (IF) staining of PVs to visualize cardiomyocytes and their interconnections within the PVs.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Adhesion slides</td>
			<td>Epredia</td>
			<td>10149870</td>
			<td></td>
		</tr>
		<tr>
			<td>AF568-secondary antibody</td>
			<td>Invitrogen</td>
			<td>A11036</td>
			<td>Host: Goat, Reactivity: Rabbit</td>
		</tr>
		<tr>
			<td>Agarose</td>
			<td>Biozym LE</td>
			<td>840104</td>
			<td></td>
		</tr>
		<tr>
			<td>Alexa Fluor 488-secondary antibody</td>
			<td>Cell Signaling Technology</td>
			<td>4408S</td>
			<td>Host: Goat, Reactivity: Mouse</td>
		</tr>
		<tr>
			<td>Anti-Connexin 43 /GJA1 antibody</td>
			<td>Abcam</td>
			<td>ab11370</td>
			<td>Polyclonal Antibody, Clone: GJA1, Host: Rabbit&#160;</td>
		</tr>
		<tr>
			<td>Anti-cTNT antibody</td>
			<td>Invitrogen</td>
			<td>MA5-12960</td>
			<td>Monoclonal Antibody, Clone: 13-11, Host: Mouse</td>
		</tr>
		<tr>
			<td>Bovine serum albumin</td>
			<td>Sigma-Aldrich</td>
			<td>A2153</td>
			<td></td>
		</tr>
		<tr>
			<td>Brush</td>
			<td>Lukas&#160;</td>
			<td>5486</td>
			<td>size 6</td>
		</tr>
		<tr>
			<td>Cover slips</td>
			<td>Epredia</td>
			<td></td>
			<td>24 mm x 50 mm</td>
		</tr>
		<tr>
			<td>Cryotome Cryo Star NX70</td>
			<td>Epredia&#160;</td>
			<td></td>
			<td>Settings: Specimen temperature: -18 &#176;C, Blade Temperature: -25 &#176;C</td>
		</tr>
		<tr>
			<td>DFC365FX camera</td>
			<td>Leica&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>DM6 B fluorescence microscope</td>
			<td>Leica&#160;</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Dry ice</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Dubecco&#39;s phosphate-buffered saline (DPBS) 1x conc.</td>
			<td>Gibco</td>
			<td>14040133</td>
			<td>500 mL</td>
		</tr>
		<tr>
			<td>Dumont #5FS Forceps</td>
			<td>F.S.T.</td>
			<td>91150-20</td>
			<td>2 pieces needed</td>
		</tr>
		<tr>
			<td>Fine Scissors</td>
			<td>F.S.T.</td>
			<td>14090-09</td>
			<td></td>
		</tr>
		<tr>
			<td>Fluorescence mounting medium</td>
			<td>DAKO</td>
			<td>S3023</td>
			<td></td>
		</tr>
		<tr>
			<td>Graefe Forceps</td>
			<td>F.S.T.</td>
			<td>11052-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Hoechst 33342</td>
			<td>Invitrogen</td>
			<td>H3570</td>
			<td>Cell nuclei counterstaining</td>
		</tr>
		<tr>
			<td>ImageJ</td>
			<td>FIJI</td>
			<td></td>
			<td>analysis and processing software</td>
		</tr>
		<tr>
			<td>LAS X</td>
			<td>Leica&#160;</td>
			<td></td>
			<td>Imaging software for Leica DM6 B</td>
		</tr>
		<tr>
			<td>Microtome blades S35</td>
			<td>Feather</td>
			<td>207500000</td>
			<td></td>
		</tr>
		<tr>
			<td>Microwave</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Normal goat serum</td>
			<td>Sigma-Aldrich</td>
			<td>S26-M</td>
			<td></td>
		</tr>
		<tr>
			<td>O.C.T. compound</td>
			<td>Tissue-Tek</td>
			<td>4583</td>
			<td></td>
		</tr>
		<tr>
			<td>Paraformaldehyde 16%</td>
			<td>Pierce</td>
			<td>28908</td>
			<td>methanol-free</td>
		</tr>
		<tr>
			<td>Pasteur pipettes</td>
			<td>VWR</td>
			<td>612-1681</td>
			<td></td>
		</tr>
		<tr>
			<td>Petri dish</td>
			<td>TPP</td>
			<td>93100</td>
			<td>100 mm diameter</td>
		</tr>
		<tr>
			<td>Rocker 3D digital</td>
			<td>IKA Sch&#252;ttler</td>
			<td>00040010000</td>
			<td></td>
		</tr>
		<tr>
			<td>Slide staining jars</td>
			<td>EasyDip</td>
			<td>M900-12</td>
			<td></td>
		</tr>
		<tr>
			<td>Specimen Molds</td>
			<td>Tissue-Tek Cryomold</td>
			<td>4557</td>
			<td>25 mm x 20 mm x 5 mm</td>
		</tr>
		<tr>
			<td>StainTray M920 staining system</td>
			<td>StainTray</td>
			<td>631-1923</td>
			<td>Staining system for 20 slides</td>
		</tr>
		<tr>
			<td>Sterican Needle</td>
			<td>Braun</td>
			<td>4657705</td>
			<td>G 27 - used for injection (step 2) and pinning (step 3 and 4) in the protocol</td>
		</tr>
		<tr>
			<td>Student Vannas Spring Scissors</td>
			<td>F.S.T.</td>
			<td>91500-09</td>
			<td></td>
		</tr>
		<tr>
			<td>Super PAP Pen Liquid Blocker</td>
			<td>Super PAP Pen</td>
			<td>N71310-N</td>
			<td></td>
		</tr>
		<tr>
			<td>Syringes</td>
			<td>Braun</td>
			<td>4606108V</td>
			<td>10 mL</td>
		</tr>
		<tr>
			<td>Tris base</td>
			<td>Roche</td>
			<td>TRIS-RO</td>
			<td>component for 1x Tris-Buffered Saline (TBS)</td>
		</tr>
		<tr>
			<td>Triton X-100</td>
			<td>Sigma-Aldrich</td>
			<td>T8787</td>
			<td></td>
		</tr>
		<tr>
			<td>Tween 20</td>
			<td>Sigma-Aldrich</td>
			<td>P2287</td>
			<td></td>
		</tr>
	</tbody>
</table>

microdissection and immunofluorescence staining of myocardial sleeves in murine pulmonary veins

Pulmonary veins (PVs) are the major source of ectopic beats in atrial arrhythmias and play a crucial role in the development and progression of atrial fibrillation (AF). PVs contain myocardial sleeves (MS) composed of cardiomyocytes. MS are implicated in the initiation and maintenance of AF, as they preserve similarities to the cardiac working myocardium, including the ability to generate ectopic electrical impulses. Rodents are widely used and may represent excellent animal models to study the pulmonary vein myocardium since cardiomyocytes are widely present all over the vessel wall. However, precise microdissection and preparation of murine PVs is challenging due to the small organ size and intricate anatomy.
We demonstrate a microscopy-guided microdissection protocol for isolating the murine left atrium (LA) together with the PVs. Immunofluorescence staining using cardiac Troponin-T (cTNT) and connexin 43 (Cx43) antibodies is performed to visualize the LA and PVs in full length. Imaging at 10x and 40x magnification provides a comprehensive view of the PV structure as well as detailed insights into the myocardial architecture, particularly highlighting the presence of connexin 43 within the MS.

Author Spotlight: Developing a Translational Model for Atrial Fibrillation Research Across Species 

Microdissection and Immunofluorescence Staining of Myocardial Sleeves in Murine Pulmonary Veins

Atrial fibrillation is the most common arrhythmia, but the complex pathophysiology is still not fully understood. With our research, we contribute to a better understanding of the mechanisms that lead to the initiation and maintenance of atrial fibrillation. Translating medical research from bench to bedside is a major challenge.To address this, we established a translational pipeline from cellular models over mouse models to large animal models and pigs, allowing us to identify and validate novel therapeutic targets. Mice are often used for studying arrhythmia. However, it is challenging to study the pulmonary veins in mice.The pulmonary veins are the main triggers for atrial fibrillation in patients. Our protocol provides an effective guideline for identifying and micro-dissecting pulmonary veins to conduct further investigations.

We performed the microdissection, staining, and imaging of the PVs in 10 12-16-week-old mice. Following the protocol, we successfully microdissected PVs together with the LA in all experimental mice and obtained sections with a comprehensive view of the PVs in eight mice. Overview images were taken at 10x magnification to identify the PV orifice (PVO) region at the LA-PV junction, the extrapulmonary PVs (PVex) (PVs in between the lung hilum and the LA-PV junction), and the intrapulmonary PVs (PVin) ...

Watch this Scientific Journal Video about Developing a Translational Model for Atrial Fibrillation Research Across Species at JoVE.com

This protocol demonstrates microscopy-guided isolation and immunofluorescence staining of murine pulmonary veins. We prepare tissue samples containing the left atrium, pulmonary veins, and the corresponding lungs and stain them for cardiac Troponin T and Connexin 43.

Pulmonary veins (PVs) are the major source of ectopic beats in atrial arrhythmias and play a crucial role in the development and progression of atrial ...