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Buschmann E, Van Steenkiste G, Boussy T, Vernemmen I, Schauvliege S, Decloedt A, van Loon G. Three-dimensional electro-anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: A case report. J Vet Intern Med 2023; 37:728-734. [PMID: 36866668 DOI: 10.1111/jvim.16668] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/07/2023] [Indexed: 03/04/2023] Open
Abstract
We describe the diagnosis and treatment of an atrioventricular accessory pathway (AP) in a horse using 3-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA). During routine evaluation of the horse, intermittent ventricular pre-excitation was identified on the ECG, characterized by a short PQ interval and abnormal QRS morphology. A right cranial location of the AP was suspected from the 12-lead ECG and vectorcardiography. After precise localization of the AP using 3D EAM, ablation was performed and AP conduction was eliminated. Immediately after recovery from anesthesia an occasional pre-excited complex still was observed, but a 24-hour ECG and an ECG during exercise 1 and 6 weeks after the procedure showed complete disappearance of pre-excitation. This case shows the feasibility of 3D EAM and RFCA to identify and treat an AP in horses.
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Affiliation(s)
- Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | - Ingrid Vernemmen
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, and Anaesthesia and Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Staikou C, Stamelos M, Stavroulakis E. Perioperative management of patients with pre-excitation syndromes. Rom J Anaesth Intensive Care 2018; 25:131-147. [PMID: 30393770 PMCID: PMC6211613 DOI: 10.21454/rjaic.7518.252.stk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022] Open
Abstract
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
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Affiliation(s)
- Chryssoula Staikou
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
| | - Mattheos Stamelos
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
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Viu J, Armengou L, Decloedt A, Jose-Cunilleras E. Investigation of ventricular pre-excitation electrocardiographic pattern in two horses: clinical presentation and potential causes. J Vet Cardiol 2018; 20:213-221. [PMID: 29573995 DOI: 10.1016/j.jvc.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 01/02/2023]
Abstract
Two horses referred to the Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, for unrelated clinical problems, and with no previous history of cardiac disease exhibited an intermittent ventricular pre-excitation electrocardiographic pattern during hospitalization. Both animals showed decreased plasma total and ionized magnesium concentrations, but no other relevant electrolyte disturbances were detected. Altered interventricular septal motion associated with ventricular pre-excitation beats (VPBs) was detected on M-mode echocardiography in both horses. The likely localization of an accessory pathway (AP) was identified in case 2 using pulsed-wave tissue Doppler imaging in the left anterior paraseptal location. Decreased frequency of the VPB was observed with long-term magnesium supplementation and restoration of plasma magnesium concentrations. The presence of ventricular pre-excitation electrocardiographic pattern was attributed to higher sensitivity of the AP to hypomagnesemia in both cases.
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Affiliation(s)
- Judit Viu
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sengul T, Saracoglu A, Sener S, Bezen O. The use of sugammadex in a pregnant patient with Wolff-Parkinson-White syndrome. J Clin Anesth 2016; 33:1-4. [PMID: 27555124 DOI: 10.1016/j.jclinane.2015.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 05/15/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Abstract
Wolff-Parkinson-White (WPW) syndrome is a rare pre-excitation syndrome which develops when atrioventricular conduction occurs through a pathologic accessory pathway known as the bundle of Kent instead of atrioventricular node, hence resulting in tachycardia. Patients with WPW syndrome may experience various symptoms arising from mild-to-moderate chest disease, palpitations, hypotension, and severe cardiopulmonary dysfunction. These patients are most often symptomatic because of cardiac arrhythmias. In this case report, we present an uneventful anesthetic management of a pregnant patient with WPW syndrome undergoing cesarean delivery. A 23-year-old American Society of Anesthesiologists class 2 pregnant patient was diagnosed with WPW syndrome. Her preoperative 12-lead electrocardiogram showed a sinus rhythm at 82 beats per minute, a delta wave, and a short PR interval. After an uneventful surgery, sugammadex 2mg/kg was administered as a reversal agent instead of neostigmine. Then she was discharged to her obstetrics service. Serious hemodynamic disorders may occur in patients with WPW syndrome due to development of fatal arrhythmias. Neostigmine used as a reversal agent in general anesthesia can trigger such fatal arrhythmias by leading changes in cardiac conduction. We believe that sugammadex, which is safely used in many areas in the scope of clinical practice, can be also used for patients diagnosed with WPW syndrome.
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Affiliation(s)
- Turker Sengul
- Department of Anesthesiology and Reanimation, Bilim University Medical Faculty, Istanbul, Turkey.
| | - Ayten Saracoglu
- Department of Anesthesiology and Reanimation, Bilim University Medical Faculty, Istanbul, Turkey
| | - Sibel Sener
- Department of Anesthesiology and Reanimation, Bilim University Medical Faculty, Istanbul, Turkey
| | - Olgac Bezen
- Department of Anesthesiology and Reanimation, Bilim University Medical Faculty, Istanbul, Turkey
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Liu Q, Kong AL, Chen R, Qian C, Liu SW, Sun BG, Wang LX, Song LS, Hong J. Propofol and arrhythmias: two sides of the coin. Acta Pharmacol Sin 2011; 32:817-23. [PMID: 21642950 DOI: 10.1038/aps.2011.42] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The hypnotic agent propofol is effective for the induction and maintenance of anesthesia. However, recent studies have shown that propofol administration is related to arrhythmias. Propofol displays both pro- and anti-arrhythmic effects in a concentration-dependent manner. Data indicate that propofol can convert supraventricular tachycardia and ventricular tachycardia and may inhibit the conduction system of the heart. The mechanism of the cardiac effects remains poorly defined and may involve ion channels, the autonomic nervous system and cardiac gap junctions. Specifically, sodium, calcium and potassium currents in cardiac cells are suppressed by clinically relevant concentrations of propofol. Propofol shortens the action potential duration (APD) but lessens the ischemia-induced decrease in the APD. Furthermore, propofol suppresses both sympathetic and parasympathetic tone and preserves gap junctions during ischemia. All of these effects cumulatively contribute to the antiarrhythmic and proarrhythmic properties of propofol.
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Garg R, Sinha R, Nishad PK. Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery. Indian J Anaesth 2011; 55:167-70. [PMID: 21712875 PMCID: PMC3106391 DOI: 10.4103/0019-5049.79899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Wolff-Parkinson-White (WPW) syndrome is one of the pre-excitation syndromes in which activation of an accessory atrioventricular (AV) conduction pathway leads to bypass the AV node and cause earlier ventricular activation than the normal pathway. We report a patient with intermittent WPW syndrome who repeatedly manifested pre-excitation after subarachnoid block.
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Affiliation(s)
- Rakesh Garg
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
- Address for correspondence: Dr. Rakesh Garg, 58-E, Kavita Colony, Nangloi, Delhi-110 041, India. E-mail:
| | - Renu Sinha
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - PK Nishad
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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