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Kjeldsen ST, Jensen M, Sørensen CT, Hopster‐Iversen C, Nissen SD. Long‐term monitoring with an implantable loop recorder detects multiple episodes of paroxysmal atrial fibrillation after electrical cardioversion in a Warmblood horse. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sofie Troest Kjeldsen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Taastrup Denmark
| | - Maria Jensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Taastrup Denmark
| | - Carina Thermann Sørensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Taastrup Denmark
| | - Charlotte Hopster‐Iversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Taastrup Denmark
| | - Sarah Dalgas Nissen
- Laboratory of Cardiac Physiology, Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects. Animals (Basel) 2022; 12:ani12060698. [PMID: 35327097 PMCID: PMC8944606 DOI: 10.3390/ani12060698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/07/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in horses causing poor performance. As in humans, the condition can be intermittent in nature, known as paroxysmal atrial fibrillation (pAF). This review covers the literature relating to pAF in horses and includes references to the human literature to compare pathophysiology, clinical presentation, diagnostic tools and treatment. The arrhythmia is diagnosed by auscultation and electrocardiography (ECG), and clinical signs can vary from sudden loss of racing performance to reduced fitness or no signs at all. If left untreated, pAF may promote electrical, functional and structural remodeling of the myocardium, thus creating a substrate that is able to maintain the arrhythmia, which over time may progress into permanent AF. Long-term ECG monitoring is essential for diagnosing the condition and fully understanding the duration and frequency of pAF episodes. The potential to adapt human cardiac monitoring systems and computational ECG analysis is therefore of interest and may benefit future diagnostic tools in equine medicine.
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Vernemmen I, Van Steenkiste G, Dufourni A, Decloedt A, van Loon G. Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence. J Vet Intern Med 2022; 36:758-769. [PMID: 35246994 PMCID: PMC8965264 DOI: 10.1111/jvim.16395] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/26/2022] Open
Abstract
Background Transvenous electrical cardioversion (TVEC) is 1 of the main treatment options for atrial fibrillation (AF) in horses. Large‐scale studies on factors affecting success and prognosis have primarily been performed in Standardbred populations. Hypothesis/Objectives To determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a predominant Warmblood study sample. Animals TVEC records of 199 horses. Methods Retrospective study of TVEC procedures of horses admitted for AF without severe echocardiographic abnormalities. Horse and procedural factors for success and cumulative amount of energy (≤ 600 J vs > 600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence. Results Two hundred and thirty‐one TVEC procedures were included, with a 94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151, 95% CI 0.032‐0.715, P = .02) and AF cycle length (OR 1.05, 95% CI 1.01‐1.09, P = .02) were independent determinants for success. Catheter type (OR 0.154, 95% CI 0.074‐0.322, P < .001), previous AF episode (OR 3.10, 95% CI 1.20‐8.01, P = .02), tricuspid regurgitation (OR 2.54, 95% CI 1.25‐5.13, P = .01), and body weight (OR 1.009, 95% CI 1.003‐1.015, P = .004) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05, 95% CI 1.34‐6.95, P = .008), mitral regurgitation (HR 1.91, 95% CI 1.08‐3.38, P = .03), and AF duration (HR 1.001, 95% CI 1.0001‐1.0026, P = .04). Conclusions and Clinical Importance Both horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Alexander Dufourni
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Eberhardt C, Schwarzwald CC. Quantification of left atrial contractile function using two-dimensional speckle tracking echocardiography in horses after conversion of atrial fibrillation to sinus rhythm. J Vet Cardiol 2021; 35:108-120. [PMID: 33940552 DOI: 10.1016/j.jvc.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES In horses, persistent atrial dysfunction is a prognostic indicator of recurrence of atrial fibrillation (AF). The objective of this study was to quantify left atrial (LA) contractile function in Warmblood horses after successful cardioversion of AF to sinus rhythm, using standard two-dimensional echocardiography (2DE) and two-dimensional speckle tracking (2DST) analyses, and to provide proof-of-concept for use of 2DST to detect LA contractile dysfunction in horses. ANIMALS, MATERIALS, AND METHODS Nineteen Warmblood horses with AF and successful transvenous electrical cardioversion (TVEC) or medical cardioversion using quinidine sulfate (QS) were included. Echocardiography was performed at 24 hr, 72 hr, and 1-6 months after cardioversion. Conventional 2DE-derived indices of LA size and function and global longitudinal strain (SL) and longitudinal strain rate (SRL) during LA contractile function were measured to detect differences in LA size and function over time and between treatment modalities. The association between 2DE-derived indices and global SL and SRL, respectively, and the agreement of the variables to detect LA dysfunction were assessed. RESULTS Global SL and SRL, as well as active LA fractional area change (FAC) identified cases with LA dysfunction after TVEC and QS cardioversion and proved useful to demonstrate LA functional recovery over time. Agreement between active LA FAC and SL and SRL, respectively, to diagnose atrial dysfunction was substantial to fair at 24 hr after cardioversion and decreased with time. CONCLUSION This study shows that 2DST is useful to quantify LA contractile dysfunction in horses after cardioversion of AF.
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Affiliation(s)
- C Eberhardt
- University of Zurich, Vetsuisse Faculty, Equine Department, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - C C Schwarzwald
- University of Zurich, Vetsuisse Faculty, Equine Department, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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Decloedt A, Van Steenkiste G, Vera L, Buhl R, van Loon G. Atrial fibrillation in horses Part 2: Diagnosis, treatment and prognosis. Vet J 2020; 268:105594. [PMID: 33468306 DOI: 10.1016/j.tvjl.2020.105594] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/27/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate monitoring is potentially interesting for AF detection by horse owners, based on the disproportionally high heart rate during exercise or increased heart rate variability. Echocardiography and laboratory analysis are useful to identify underlying cardiac disease. Horses with severe cardiac disease should not undergo cardioversion due to the risk of recurrence. Cardioversion is recommended especially in horses performing high intensity exercise or showing average maximal heart rates higher than 220 beats per min or abnormal ventricular complexes during exercise or stress. Pharmacological cardioversion can be performed using quinidine sulphate administered orally, with an overall mean reported success rate around 80%. Other therapeutic drugs have been described such as flecainide, amiodarone or novel atrial specific compounds. Transvenous electrical cardioversion (TVEC) is performed by delivering a shock between two cardioversion catheters positioned in the left pulmonary artery and right atrium, with a success rate of >95%. After cardioversion, most horses return to their previous level of performance. However, the recurrence rate after pharmacological or electrical cardioversion is up to 39%. Recurrence has been related to previous unsuccessful treatment attempts, valvular regurgitation and the presence of atrial premature depolarisations or low atrial contractile function after cardioversion. Large atrial size and long AF duration have also been suggested as risk factors. Different approaches for preventing recurrence have been described such as the administration of sotalol, however, large clinical studies have not been published.
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Affiliation(s)
- Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium.
| | - Glenn Van Steenkiste
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Lisse Vera
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gunther van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
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Takahashi Y, Ishikawa Y, Ohmura H. Treatment of recent-onset atrial fibrillation with quinidine and flecainide in Thoroughbred racehorses: 107 cases (1987-2014). J Am Vet Med Assoc 2019; 252:1409-1414. [PMID: 29772981 DOI: 10.2460/javma.252.11.1409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the efficacy of quinidine and flecainide in treating naturally occurring, recent-onset atrial fibrillation (AF) in Thoroughbred racehorses. DESIGN Retrospective case series. ANIMALS 107 Thoroughbred racehorses. PROCEDURES Medical records of racehorses with AF that were treated with quinidine or flecainide between 1987 and 2014 were reviewed. Signalment, history, treatments, complications, and outcome data were collected. Horses were allocated to 2 groups according to the initial treatment: initial treatment with quinidine (group 1) or initial treatment with flecainide (group 2). Horses in group 2 that did not convert to sinus rhythm with flecainide were then administered quinidine (group 3). Complications, total quinidine dose, and duration of treatment were compared. Rates of conversion for horses treated with quinidine versus flecainide were also compared. RESULTS Overall rate of cardioversion was 91% (97/107). There was a significant difference in the rate of cardioversion for quinidine alone (91% [71/78]), compared with flecainide alone (41% [12/29]). In group 3, the conversion rate after the addition of quinidine treatment was 82% (14/17). Total quinidine dose and treatment duration did not differ significantly between groups 1 and 3. CONCLUSIONS AND CLINICAL RELEVANCE Overall rate of cardioversion for Thoroughbred racehorses with AF was similar to that in previous reports. Flecainide treatment was less effective than quinidine treatment, but the frequency of complications did not differ between quinidine and flecainide. Further investigation is suggested to evaluate the efficacy of flecainide for cardioversion in athletic horses.
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Van Steenkiste G, De Clercq D, Vera L, Decloedt A, Loon G. Sustained atrial tachycardia in horses and treatment by transvenous electrical cardioversion. Equine Vet J 2019; 51:634-640. [DOI: 10.1111/evj.13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/06/2019] [Indexed: 01/10/2023]
Affiliation(s)
- G. Van Steenkiste
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - D. De Clercq
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - L. Vera
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - A. Decloedt
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - G. Loon
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
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Broux B, De Clercq D, Vera L, Ven S, Deprez P, Decloedt A, van Loon G. Can heart rate variability parameters derived by a heart rate monitor differentiate between atrial fibrillation and sinus rhythm? BMC Vet Res 2018; 14:320. [PMID: 30359273 PMCID: PMC6203204 DOI: 10.1186/s12917-018-1650-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) parameters, and especially RMSSD (root mean squared successive differences in RR interval), could distinguish atrial fibrillation (AF) from sinus rhythm(SR) in horses, as was demonstrated in a previous study. If heart rate monitors (HRM) automatically calculating RMSSD could also distinguish AF from SR, they would be useful for the monitoring of AF recurrence. The objective of the study was to assess whether RMSSD values obtained from a HRM can differentiate AF from SR in horses. Furthermore, the impact of artifact correction algorithms, integrated in the analyses software for HRV analyses was evaluated. Fourteen horses presented for AF treatment were simultaneously equipped with a HRM and an electrocardiogram (ECG). A two-minute recording at rest, walk and trot, before and after cardioversion, was obtained. RR intervals used were those determined automatically by the HRM and by the equine ECG analysis software, and those obtained after manual correction of QRS detection within the ECG software. RMSSD was calculated by the HRM software and by dedicated HRV software, using six different artifact filters. Statistical analysis was performed using the Wilcoxon signed-rank test and receiver operating curves. RESULTS The HRM, which applies a low level filter, produced high area under the curve (AUC) (> 0.9) and cut off values with high sensitivity and specificity. Similar results were obtained for the ECG, when low level artifact filtering was applied. When no artifact correction was used during trotting, an important decrease in AUC (0.75) occurred. CONCLUSION In horses treated for AF, HRMs with automatic RMSSD calculations distinguish between AF and SR. Such devices might be a useful aid to monitor for AF recurrence in horses.
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Affiliation(s)
- B Broux
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium.
| | - D De Clercq
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - L Vera
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - S Ven
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - P Deprez
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - A Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - G van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
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Mitchell K, De Clercq D, Stirn M, van Loon G, Schwarzwald C. Plasma homocysteine concentrations in healthy horses and horses with atrial fibrillation. J Vet Cardiol 2018; 20:276-284. [DOI: 10.1016/j.jvc.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 11/16/2022]
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Vandecasteele T, Cornillie P, van Steenkiste G, Vandevelde K, Gielen I, Vanderperren K, van Loon G. Echocardiographic identification of atrial-related structures and vessels in horses validated by computed tomography of casted hearts. Equine Vet J 2018; 51:90-96. [DOI: 10.1111/evj.12969] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
| | - P. Cornillie
- Department of Morphology; Ghent University; Merelbeke Belgium
| | - G. van Steenkiste
- Department of Large Animal Internal Medicine; Ghent University; Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Ghent University; Merelbeke Belgium
| | - I. Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics; Ghent University; Merelbeke Belgium
| | - K. Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Ghent University; Merelbeke Belgium
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Kraus M, Physick-Sheard P, Brito LF, Sargolzaei M, Schenkel FS. Marginal ancestral contributions to atrial fibrillation in the Standardbred racehorse: Comparison of cases and controls. PLoS One 2018; 13:e0197137. [PMID: 29763439 PMCID: PMC5953485 DOI: 10.1371/journal.pone.0197137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/26/2018] [Indexed: 11/30/2022] Open
Abstract
Admissions of Standardbred racehorses (Std) to the Ontario Veterinary College Teaching Hospital (OVCTH) for treatment of atrial fibrillation (AF) began to increase in the early 1990s. The arrhythmia has been shown to have a modest heritability (h2 ≃ 0.15), with some stallions appearing as sires or sires of mares used in breeding (broodmares) of affected horses more frequently than others. The objective of this study was to determine the marginal genetic contributions of ancestors to cohorts of Std affected with AF and their contemporary control groups, and whether these ancestors contribute significantly more to the affected cohorts than to controls. All Std admitted to OVCTH for treatment of AF that were born between 1993 and 2007 comprised the affected case group (n = 168). Five randomly selected racing contemporaries for each Std admitted, assumed to not suffer from the arrhythmia, comprised the control group (n = 840). Three-year overlapping cohorts were created for case and control horses, determined according to year of birth, for a total of 26 cohorts. Marginal genetic contributions of ancestors to each cohort were determined and differences analyzed for statistical significance using a two-tailed paired t-test, with P ≤ 0.05 considered significant. The marginal contributions of 26 ancestors were significant, with 11 contributing significantly more to affected cohorts than the corresponding controls, and 15 contributing significantly more to controls than the corresponding affected cohorts. One stallion and one broodmare were very highly significant to affected cohorts at P ≤ 0.001, and nine stallions and three broodmares were very highly significant to control cohorts at P ≤ 0.001. Therefore, a number of stallions have statistically significant contributions to the genetics of Std affected with AF, while many others have statistically significant contributions to healthy Std. The arrhythmia appears to be particularly prevalent in the descendants of one sire family.
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Affiliation(s)
- Megan Kraus
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
| | - Peter Physick-Sheard
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Luiz F. Brito
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
| | - Mehdi Sargolzaei
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
- The Semex Alliance, Guelph, Ontario, Canada
| | - Flávio S. Schenkel
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada
- * E-mail:
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Broux B, De Clercq D, Decloedt A, Ven S, Vera L, van Steenkiste G, Mitchell K, Schwarzwald C, van Loon G. Heart rate variability parameters in horses distinguish atrial fibrillation from sinus rhythm before and after successful electrical cardioversion. Equine Vet J 2017; 49:723-728. [DOI: 10.1111/evj.12684] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/14/2017] [Indexed: 12/22/2022]
Affiliation(s)
- B. Broux
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - D. De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - A. Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - S. Ven
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - L. Vera
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Steenkiste
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - K. Mitchell
- Equine Clinic; University of Zurich; Zurich Switzerland
| | | | - G. van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
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13
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Atrial fibrillation management in a breeding stallion. J Vet Cardiol 2017; 19:299-307. [PMID: 28336184 DOI: 10.1016/j.jvc.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/21/2016] [Accepted: 02/08/2017] [Indexed: 11/23/2022]
Abstract
A 20-year-old warmblood breeding stallion presented to a University practice for semen collection and evaluation was incidentally diagnosed with atrial fibrillation (AF). Electrocardiogram recordings during breeding revealed inappropriately rapid tachycardia and occasional ventricular premature depolarizations/aberrant ventricular conduction. Transvenous electrical cardioversion was performed. After successful cardioversion the horse displayed supraventricular ectopy and atrial contractile dysfunction and was administered sotalol hydrochloride in an attempt to decrease the risk of AF recurrence. Supraventricular ectopy and echocardiographic evidence of atrial dysfunction gradually improved and normalized over 6 months. No direct adverse effects of the chronic anti-arrhythmic treatment were observed and libido and semen quality were unaffected. AF recurred 6 months after cardioversion and sotalol therapy was continued to control the ventricular ectopy/aberrant ventricular conduction during semen collection. Considerations regarding pathologic arrhythmias and inappropriately high heart rates in breeding stallions with AF may be similar to those in riding horses. Sotalol hydrochloride was a safe anti-arrhythmic drug in the management of this case.
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15
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Potter B, Scansen B, Dunbar L, Reed S, Toribio R. Transcutaneous direct current cardioversion in a foal with lone atrial fibrillation. J Vet Cardiol 2017; 19:99-105. [DOI: 10.1016/j.jvc.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Bozorgmanesh R, Magdesian KG, Estell KE, Stern JA, Swain EA, Griffiths LG. Atrial Fibrillation in Eight New World Camelids. J Vet Intern Med 2015; 30:335-8. [PMID: 26647783 PMCID: PMC4913670 DOI: 10.1111/jvim.13798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/08/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is limited information on the incidence of clinical signs, concurrent illness and treatment options for atrial fibrillation (AF) in New World Camelids (NWC). Objective Describe clinical signs and outcome of AF in NWC. Animals Eight New World Camelids admitted with AF. Methods A retrospective observational study of camelids diagnosed with AF based on characteristic findings on electrocardiogram (ECG). Results All animals had an irregularly irregular heart rhythm detected on physical examination and 4 cases had obtunded mentation on admission. Three camelids were diagnosed with AF secondary to oleander intoxication, 3 animals had underlying cardiovascular disease, 1 was diagnosed with lone AF and 1 had AF diagnosed on examination for a urethral obstruction. Five of eight animals survived to discharge and nonsurvivors consisted of animals which died or were euthanized as a result of cardiovascular disease (2/8) or extra‐cardiac disease unrelated to the AF (1/8). Conclusions and Clinical Importance Atrial fibrillation occurs in NWC in association with cardiovascular disease, extra‐cardiac disease or as lone AF. Amiodarone and transthoracic cardioversion were attempted in one llama with lone AF, but were unsuccessful. Atrial fibrillation was recorded in 0.1% of admissions.
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Affiliation(s)
- R Bozorgmanesh
- School of Veterinary Medicine, Veterinary Medical Teaching Hospital, University of California, Davis, CA
| | - K G Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
| | - K E Estell
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
| | - J A Stern
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
| | - E A Swain
- School of Veterinary Medicine, Veterinary Medical Teaching Hospital, University of California, Davis, CA
| | - L G Griffiths
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
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McGurrin MKJ. The diagnosis and management of atrial fibrillation in the horse. VETERINARY MEDICINE (AUCKLAND, N.Z.) 2015; 6:83-90. [PMID: 30101098 PMCID: PMC6067668 DOI: 10.2147/vmrr.s46304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation is the most common performance-limiting arrhythmia in the horse. Detailed cardiovascular evaluation will help guide prognosis and treatment. Many affected horses have lone atrial fibrillation (no predisposing cardiac abnormalities). These horses have a good prognosis for return to performance if sinus rhythm can be restored. The main therapeutic option continues to be quinidine, which has been used for over 60 years. Transvenous electrical cardioversion has proven to be a successful alternative. Other therapeutic options are being explored, but are currently limited.
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Affiliation(s)
- M Kimberly J McGurrin
- Health Sciences Centre, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada,
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Physick-Sheard P, Kraus M, Basrur P, McGurrin K, Kenney D, Schenkel F. Breed predisposition and heritability of atrial fibrillation in the Standardbred horse: a retrospective case-control study. J Vet Cardiol 2014; 16:173-84. [PMID: 25087649 DOI: 10.1016/j.jvc.2014.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 03/02/2014] [Accepted: 03/07/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess evidence for genetic contributions to atrial fibrillation (AF) in the Standardbred horse. ANIMALS Equine referrals to the Ontario Veterinary College Health Sciences Centre (OVCHSC) for 1985-2009, and age and gait matched breed registry controls. METHODS Breeds presenting ≥ 5 times annually were tabulated (admission year and diagnosis; total 40,039; AF 396; no AF 39,643), and breed and year effects examined. Heritability and inbreeding coefficients were determined for Standardbred AF cases and racing contemporaries, and odds ratios for AF were calculated for frequently occurring sires. RESULTS Year and breed effects on diagnosis were highly significant (Chi-Square 212.85, p < 0.0001, and 304.25, p < 0.0001, respectively). Year effect on diagnosis by breed was significant from 1997, and due to Standardbred admissions each year. Quarterhorses were significantly less likely to present with AF (OR 0.0578-0.6048), Standardbreds were more likely (OR 4.3874-10.9006). Heritability of AF on the underlying scale (h²(u)) was estimated at 29.6 ± 3.9% and on the observed binomial scale (h²(o)), at 9.6%. For horses born in 1994 or later, h²(u) was 31.1 ± 4.3% and h²(o), 10.1%. Of 22 first generation sires appearing ≥ 10 times in the case/control file, seven pacing and one trotting sire produced affected horses more frequently than expected (OR 2.66-66.32). Inbreeding was not a factor. CONCLUSIONS There is genetic liability to AF in Standardbred horses, likely due to more than single genes with simple Mendelian inheritance. Genomic studies are required.
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Affiliation(s)
- Peter Physick-Sheard
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
| | - Megan Kraus
- Department of Animal Science, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Pari Basrur
- Department of Biomedical Sciences, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Kimberly McGurrin
- Ontario Veterinary College Health Sciences Centre, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Daniel Kenney
- Ontario Veterinary College Health Sciences Centre, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Flavio Schenkel
- Department of Animal Science, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
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Reef VB, Bonagura J, Buhl R, McGurrin MKJ, Schwarzwald CC, van Loon G, Young LE. Recommendations for management of equine athletes with cardiovascular abnormalities. J Vet Intern Med 2014; 28:749-61. [PMID: 24628586 PMCID: PMC4895474 DOI: 10.1111/jvim.12340] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022] Open
Abstract
Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.
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Affiliation(s)
- V B Reef
- Department of Clinical Studies-New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
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20
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De Clercq D, Decloedt A, Sys SU, Verheyen T, Van Der Vekens N, van Loon G. Atrial fibrillation cycle length and atrial size in horses with and without recurrence of atrial fibrillation after electrical cardioversion. J Vet Intern Med 2014; 28:624-9. [PMID: 24611990 PMCID: PMC4858013 DOI: 10.1111/jvim.12322] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 11/20/2013] [Accepted: 01/08/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) cycle length (CL) and atrial size have been used in humans to characterize electrical and structural remodeling to predict outcome of cardioversion of AF and risk for AF recurrence (rAF). HYPOTHESIS Atrial fibrillation cycle length can be determined in horses with AF, and AFCL and atrial size are related to risk for rAF. ANIMALS Eighteen horses with naturally occurring AF that were successfully converted to sinus rhythm (SR) by transvenous electrical cardioversion (TVEC). METHODS Prospective study. Horses with severe valvular regurgitation, left atrial enlargement, or that required sedation for catheter placement were excluded. In all horses intra-atrial electrograms were recorded and estimated AF duration and echocardiographic parameters were determined before TVEC. The follow-up time was 1 year after TVEC. RESULTS Atrial fibrillation cycle length could be determined in all horses. The AFCL and the shortest 5th percentile (p5) AFCL in horses with rAF (n = 6 or 33%) were (mean ± SD) 157 ± 28 and 134 ± 24 milliseconds, respectively, and in those maintaining SR (n = 12 or 67%) 166 ± 13 and 141 ± 13 milliseconds, respectively. Significant parameters to predict rAF were (1) the ratios of the p5AFCL to the left atrium (LA) sizes corrected to the size of aorta (AO) and (2) LA sizes corrected to the size of AO. CONCLUSIONS AND CLINICAL IMPORTANCE Before TVEC, assessment of LA size and atrial electrophysiologic characteristics might help to identify horses at increased risk for AF recurrence.
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Affiliation(s)
- D De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Preiss EE, Kenney DG, McGurrin MKJ, Physick-Sheard PW. Influence of electrode position on cardioversion energy requirements during transvenous electrical cardioversion in horses. Am J Vet Res 2011; 72:1193-203. [DOI: 10.2460/ajvr.72.9.1193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schauvliege S, van Loon G, De Clercq D, Devisscher L, Deprez P, Gasthuys F. Cardiovascular responses to transvenous electrical cardioversion of atrial fibrillation in anaesthetized horses. Vet Anaesth Analg 2009; 36:341-51. [PMID: 19538571 DOI: 10.1111/j.1467-2995.2009.00470.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the influence of direct current shock application in anaesthetized horses with atrial fibrillation (AF) and to study the effects of cardioversion to sinus rhythm (SR). STUDY DESIGN Prospective clinical study. ANIMALS Eight horses successfully treated for AF (transvenous electrical cardioversion after amiodarone pre-treatment). METHODS Cardioversion catheters and a pacing catheter were placed under sedation [detomidine 10 microg kg(-1) intravenously (IV)]. After additional sedation (5-10 microg kg(-1) detomidine, 0.1 mg kg(-1) methadone IV), anaesthesia was induced with ketamine, 2.2 mg kg(-1) and midazolam, 0.06 mg kg(-1) (IV) in a sling and maintained with isoflurane in oxygen. Flunixin meglumine, 1.1 mg kg(-1), was administered IV. Shocks were delivered as biphasic truncated exponential waves, synchronized with the R-wave of the electrocardiogram. Monitoring included pulse oximetry, electrocardiography, capnography, inhalational anaesthetic agent concentration, arterial blood pressure, LiDCO and PulseCO cardiac index (CI) and arterial blood gases. Values before and after the first unsuccessful shock and before and after cardioversion to SR were compared. RESULTS Values before the first shock were comparable to reported values in healthy, isoflurane anaesthetized horses. Reliable CI measurements could not be obtained using the PulseCO technique. Intermittent positive pressure ventilation was required in most horses (bradypnea and/or PaCO(2) >8 kPa, 60 mmHg), while dobutamine was administered in two horses (0.3-0.5 microg kg(-1) minute(-1)). After the 1st unsuccessful shock application, systolic arterial pressure (SAP) was decreased (p = 0.025), other recorded values were not influenced (CI measurements not available for this analysis). SR was associated with increases in CI (p = 0.039) and stroke index (p = 0.002) and a decrease in SAP (p = 0.030). CONCLUSIONS AND CLINICAL RELEVANCE Despite the presence of AF, cardiovascular function was well maintained during anaesthesia and was not affected by shock application. Cardiac index and stroke index increased and SAP decreased after cardioversion.
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Affiliation(s)
- Stijn Schauvliege
- Faculty of Veterinary Medicine, Department of Surgery and Anaesthesia of Domestic Animals, Ghent University, Salisburylaan, Merelbeke, Belgium.
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Jesty S, Kraus M, Gelzer A, Rishniw M, Moïse N. Effect of Transvenous Electrical Cardioversion on Plasma Cardiac Troponin I Concentrations in Horses with Atrial Fibrillation. J Vet Intern Med 2009; 23:1103-7. [DOI: 10.1111/j.1939-1676.2009.0369.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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De Clercq D, van Loon G, Tavernier R, Verbesselt R, Deprez P. Use of propafenone for conversion of chronic atrial fibrillation in horses. Am J Vet Res 2009; 70:223-7. [PMID: 19231955 DOI: 10.2460/ajvr.70.2.223] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate effects of IV administration of propafenone for naturally occurring and experimentally induced chronic atrial fibrillation in horses. ANIMALS 2 horses with naturally occurring atrial fibrillation and 4 horses with pacing-induced atrial fibrillation. PROCEDURES Horses received a bolus of propafenone (2 mg/kg, IV over 15 minutes). If atrial fibrillation persisted after 20 minutes, a continuous infusion of propafenone (7 microg/kg/min) was given for 120 minutes. Before, during, and after treatment, plasma propafenone concentrations, hematologic and serum biochemical values, and electolyte concentrations analyses were determined and clinical signs were monitored. Surface ECGs were recorded. If propafenone treatment failed, quinidine sulfate was administered. RESULTS Bolus and continuous infusion induced minimal adverse effects. During the 15-minute bolus administration, a slight increase in heart rate was observed and horses appeared more sensitive to external stimuli. Throughout treatment, no significant changes were observed in respiratory rate, QRS or corrected QT duration, or results of hematologic analyses. Although a significant increase in F-wave interval and atrial fibrillation cycle length was observed and plasma propafenone concentrations (569 to 1,268 ng/mL) reached the human therapeutic range (64 to 1,044 ng/mL), none of the horses cardioverted to sinus rhythm. Sinus rhythm could be restored in all horses via standard oral administration of quinidine. CONCLUSIONS AND CLINICAL RELEVANCE A slow IV bolus of 2 mg of propafenone/kg followed by a continuous infusion of 7 microg/kg/min over 2 hours was not an effective treatment for chronic atrial fibrillation in horses.
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Affiliation(s)
- Dominique De Clercq
- Department of Large Animal Internal Medicine, Ghent University, Salisburylaan 133, B-9820, Merelbeke, Belgium
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Ventricular rate control using a novel vagus nerve stimulating system in a dog with chronic atrial fibrillation. J Vet Cardiol 2008; 10:147-54. [DOI: 10.1016/j.jvc.2008.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 08/19/2008] [Accepted: 09/19/2008] [Indexed: 11/23/2022]
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Transvenous electrical cardioversion of atrial fibrillation in six horses using custom made cardioversion catheters. Vet J 2007; 177:198-204. [PMID: 17920965 DOI: 10.1016/j.tvjl.2007.08.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 08/10/2007] [Accepted: 08/18/2007] [Indexed: 11/23/2022]
Abstract
Pharmacological conversion of atrial fibrillation (AF) to sinus rhythm in horses can be difficult. The objective of this study was to investigate the feasibility of transvenous electrical cardioversion with custom made catheters in eight horses, of which three had failed cardioversion using quinidine sulfate. Two cardioversion catheters and one pacing/sensing electrode were inserted via the right jugular vein and placed using ultrasound guidance into the left pulmonary artery, the right atrium and the right ventricle, respectively. Because immediate recurrence of AF was encountered in the second horse treated, pre-treatment with amiodarone was given to each of the remaining six horses. Induction of general anaesthesia was associated with dislocation of the cardioversion catheter in three horses, requiring a second catheterisation procedure. During general anaesthesia, biphasic R wave synchronised shocks of up to 360 J were delivered between both cardioversion electrodes. In six horses (75%), including two which had failed quinidine sulfate treatment, sinus rhythm was restored with a mean energy level of 295+/-62 J. No side effects were observed. Blood analysis 3 h after cardioversion revealed normal parameters, including cardiac troponin I values. Transvenous electrical cardioversion of atrial fibrillation with custom made cardioversion catheters can be considered as a treatment option for atrial fibrillation in horses, especially when conventional drugs fail.
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Schwarzwald CC, Schober KE, Bonagura JD. Echocardiographic Evidence of Left Atrial Mechanical Dysfunction after Conversion of Atrial Fibrillation to Sinus Rhythm in 5 Horses. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03027.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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