Pathological Features of Persistent Atrial Standstill Syndrome in Three Dogs

Clinical presentation, management, and survival in dogs with persistent atrial standstill in the United Kingdom

OBJECTIVES

To investigate the clinical and echocardiographic presentation of dogs with persistent atrial standstill (PAS), identify variables measured at first presentation that could predict their survival, and document the progression of the disease after pacing.

MATERIALS AND METHODS

Retrospective study of medical records of dogs diagnosed with PAS at three referral hospitals of the United Kingdom over seven years.

RESULTS

Twenty-six dogs were diagnosed with PAS during the study period. Median age of the population was three years (range: 7 months-12.5 years). The most common clinical sign was syncope (14/26). Twenty-four dogs received artificial pacemakers (PM). Major complications after PM implantation were observed in four dogs (4/24). Serial echocardiographic examinations showed that cardiac dimensions of PAS dogs with left atrial or left ventricular dilation at first presentation did not return to reference range after pacing. Further dilation of the cardiac chambers, recurrence of congestive heart failure (CHF), or development of new episodes of CHF were documented in 7, 4, and 10 PAS dogs, respectively, despite pacing. Median survival time for cardiac-related deaths after PM implantation was 1512 days (18-3207). Neither CHF nor echocardiographic variables at presentation predicted survival after PM implantation in PAS dogs.

CONCLUSIONS

PAS is an uncommon bradyarrhythmia, occurring in young adult dogs. Affected dogs were often presented with syncope. Whilst syncope resolved, cardiac remodeling persisted after PM implantation. Long-term survival was favorable after PM implantation and was not predicted by congestive status or cardiac chamber size at first presentation.

The Anatomical Substrate for Sick Sinus Syndrome in Dogs

The hearts of 28 dogs, clinically diagnosed as having symptomatic sick sinus syndrome (SSS), were examined post mortem, with a particular focus on the sinus node (SN) region. The affected dogs were divided into two groups according to the findings of ambulatory electrocardiography: 16 dogs with severe sinoatrial (SA) block and/or sinus arrest (group A) and 12 dogs with long sinus or atrial pauses due to SA block and/or sinus arrest accompanied by atrial tachyarrhythmias (group B). The most significant histopathological changes found in both SSS groups were extensive destruction of the SN characterized by depletion of nodal cells with fatty or fibrofatty replacement and interruption of contiguity between the SN and the surrounding atrial myocardium. Furthermore, in group B, the SN lesions were combined with fibrosis of the atrial myocardium. The results of this investigation improve our understanding of the close relationship between the electrocardiogram findings and pathological alterations in each group. Because most human cases of SSS are due to degenerative fibrosis of the SN, the loss and disappearance of nodal cells with a corresponding increase in fatty or fibrofatty tissue, may be specific to canine cases of SSS.