Influence of 2nd-degree AV blocks, ECG recording length, and recording time on heart rate variability analyses in horses

Evaluation of vasovagal tonus index and electrocardiographic parameters in horses using a new modified base apex lead method

Background and Aim

Vasovagal tonus index (VVTI) serves as a straightforward assessment tool for autonomic function during both physiological and pathological conditions, including pregnancy, in horses. Obtaining VVTI through a modified base apex lead system could be a practical and comfortable solution. In this study, we assessed VVTI in horses with respect to training status and electrocardiographic measurements utilizing a novel modified base apex lead technique.

Materials and Methods

A total of 12 Thai native crossbred horses and 12 Arabian horses, all free of cardiac abnormalities, were enrolled in the study. Animals underwent electrocardiogram (ECG) and VVTI using both the base-apex lead method and its modified version. 25 mm/s and 10 mm/mV ECG recordings provided standard bipolar limb leads. The amplitudes and durations of P waves, QRS complexes, PR interval, QT interval, and T duration were assessed. The T wave's shape was examined. Each recording's R-R interval was utilized to assess heart rate. Twenty consecutive beats were used to compute the variability of heart rate (VVTI).

Results

The P wave amplitude was the only significant difference (p < 0.05) between the base apex lead method and the modified base apex lead method, with no variations in heart rate, P duration, PR interval, T duration, and QRS duration and amplitude. Both methods showed mainly biphasic T wave patterns. The VVTI values of all horses did not differ significantly between the base apex and modified base apex methods. There was no significant difference in VVTI between Thai crossbred horses and Arabian horses in either method.

Conclusion

This study provided the first evidence that VVTI can be evaluated using the modified base apex lead system and may be useful for cardiovascular function monitoring in horses.

Comparison of daily heart rate and heart rate variability in trained and sedentary aged horses

Athletic horses are usually retired from equestrian competition at an advanced age. Aged horses may then continue to have regular exercise or are sedentary. The comparison of autonomic regulation between sedentary aged horses (SAH) and trained aged horses (TAH) after retirement remains unpublished. This study compared daily heart rate (HR) and heart rate variability between 11 SAH and 11 TAH over 22 h (07.00 h to 05.00 h on an alternate day) and during the day and night. An increase in mean beat-to-beat (RR) intervals (p < 0.01-0.0001) and parasympathetic nervous system (PNS) index (p < 0.05-0.0001), corresponding to the decreased HR and sympathetic nervous system (SNS) index (p < 0.01-0.0001), was observed at night. Compared to SAH, lowered mean HR and SNS index, corresponding to elevated mean RR intervals and very-low-frequency bands, were marked in TAH during the day (p < 0.05 for all variables). Whereas the standard deviation of the RR intervals index was higher in TAH than in SAH during the day and night (p < 0.05 for both periods). It was suggested that aged horses with different physical activities revealed distinct autonomic responses. TAH demonstrated higher HRV than SAH during the day. A decreased HR in TAH is prone to result from a reduced SNS role, leading to a shift toward more PNS activity during the day. More research is warranted to determine to what extent the autonomic regulation is modulated by accompanying higher exercise volume or programmed exercise in aged horses.

Changes in Heart Rate Variability with Induction of Gastric Ulcers in Adult Horses

Gastric ulceration can be induced by athletic training and is a significant welfare concern. The objective of this study was to evaluate the effect of gastric ulcer induction on heart rate variability (HRV) in the horse. We hypothesized that induction of gastric ulcers would decrease HRV and increase low frequency fluctuations, consistent with increased sympathetic tone. A convenience sample of 8 horses in a larger study were enrolled. Horses were randomly assigned to receive water or 2 mg/kg omeprazole orally once daily for 28 days. Gastric ulcers were induced through intermittent feed withholding on days 21 to 28. Gastroscopy was performed and gastric ulcers were graded (0-IV) by three blinded reviewers on days 21 and 28. Continuous electrocardiograms were obtained for one hour at the start and end of ulcer induction. HRV was assessed in 1-hour recordings for time domain variables and 5 minute sections for frequency domain analysis. HRV and ulcer grade across treatments were compared by a mixed effect model, with treatment and time as fixed effects and horse as a random effect. Gastric ulcer grade increased with induction protocol (P < .0001) and decreased with omeprazole treatment (P = .0007). Omeprazole treatment increased R-R intervals (P = .01) and decreased ratio of low frequency/high frequency signal (P = .008) as compared to horses receiving water. This was attributable to decreasing low frequency fluctuations (P = .05). While limited by the small sample size (four horses/treatment), this study suggests that omeprazole treatment decreases heart rate, and LF/HF ratio during ulcer induction, consistent with a decrease in sympathetic tone.

Validation of an Equine Smart Textile System for Heart Rate Variability: A Preliminary Study

Electrocardiograms (ECGs), and associated heart rate (HR) and heart rate variability (HRV) measurements, are essential in assessing equine cardiovascular health and fitness. Smart textiles have gained popularity, but limited validation work has been conducted. Therefore, the objective of this study was to compare HR and HRV data obtained using a smart textile system (Myant) to the gold-standard telemetric device (Televet). Simultaneous ECGs were obtained using both systems in seven horses at rest and during a submaximal exercise test. Bland-Altman tests were used to assess agreement between the two devices. Strong to perfect correlations without significant differences between the two devices were observed for all metrics assessed. During exercise, mean biases of 0.31 bpm (95% limits of agreement: -1.99 to 2.61) for HR, 1.43 ms (-11.48 to 14.33) for standard deviation of R-R intervals (SDRR), and 0.04 (-2.30 to 2.38) for the HRV triangular index (TI) were observed. A very strong correlation was found between the two devices for HR (r = 0.9993, p < 0.0001) and for HRV parameters (SDRR r = 0.8765, p < 0.0001; TI r = 0.8712, p < 0.0001). This study demonstrates that a smart textile system is reliable for assessment of HR and HRV of horses at rest and during submaximal exercise.

Comparison of Jugular vs. Saphenous Blood Samples, Intrarater and In-Between Device Reliability of Clinically Used ROTEM S Parameters in Dogs

Rotational Thromboelastometry (ROTEM) allows for the global assessment of hemostasis in whole blood samples. Preanalytical and analytical factors may influence test results, and data about the reliability and reproducibility of lyophilized ROTEM tests are scarce. Therefore, the objective of this study was to evaluate the influence of blood collection site on ROTEM S parameters and to assess intrarater and in-between device variability. A total of thirty, healthy, staff-owned dogs were included. Blood collection and ROTEM analysis were performed by trained staff according to a standardized protocol. Extrinsically activated (tissue factor; Ex-TEM S), with the addition of cytochalasin for platelet inhibition (Fib-TEM S), and intrinsically activated (In-TEM) analyses were performed. Analysis of our data showed significant variability for various Ex-TEM S and Fib-TEM S parameters from different collection sites and intrarater and in-between device measurements. We conclude that serial monitoring with ROTEM should be performed on the same device, with blood always taken from the same collection site using a standardized blood sampling technique. While In-TEM S, apart from maximum lysis, showed very stable and reliable results, we suggest interpreting especially clotting and clot formation parameters from Ex-TEM S and Fib-TEM S tests with caution and using duplicate measurements to detect outliers and to prevent initiation of incorrect therapies.

Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects

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.

Evaluation of a novel ambulatory electrocardiogram monitor (the Carnation Ambulatory Monitor) for use in horses

INTRODUCTION

Short-term electrocardiogram (ECG) examinations of horses may not detect paroxysmal arrhythmias. Twenty-four hour Holter equipment can be unwieldy and inconvenient for long-term use. This study evaluated a novel long-term ECG patch recorder, the Carnation Ambulatory Monitor (CAM) in horses, determining ideal placement, practicality, durability and performance.

ANIMALS

Twenty-one adult mixed-breed horses.

METHODS

Prospective observational study. Three horses had ECG patches fitted at selected sites (phase 1); the two most promising sites were used for further wear testing (phase 2) and the best site was chosen for a trial in 18 horses (phase 3), 16 of which had presented for evaluation of cardiac disease. In phase 1, the CAM was compared with a standard telemetric ECG. The CAM ECGs were analysed using proprietary software.

RESULTS

The most promising sites for CAM placement were the ventral midline caudal to the xiphisternum and left thorax caudal to the girth. The ventral midline was chosen for further evaluation. The CAM provided reliable and generally excellent ECG quality at rest (median quality score 4.5/5, range 3-5), over extended periods, allowing detection of arrhythmias. The ECG quality was poor during exercise (median quality score 1, range 1-5), except in three horses. In 15/17 placements in the standing horse, greater than 85% of the potential recording time was achieved.

CONCLUSIONS

The CAM is a convenient and well-tolerated device for evaluating equine cardiac rhythm at rest over long periods. Further evaluation of the ideal placement site during exercise may increase its diagnostic utility.

Heart rate variability analysis in horses for the diagnosis of arrhythmias

Heart rate variability (HRV) analysis has been performed on ECG-derived data sets for more than 170 years but is currently undergoing a rapid evolution, thanks to the expansion of the human and veterinary medical technology sector. Traditional HRV analysis was initially performed to identify changes in vago-sympathetic balance, while the most recent focus has expanded to include the use of complex computer algorithms, neural networks and machine learning technology to identify cardiac arrhythmias, particularly atrial fibrillation (AF). Some of these techniques have recently been translated for use in the field of equine cardiology, with particular focus on improving the diagnosis of arrhythmias both at rest and during exercise. This review focuses on understanding the basic HRV variables and important factors to consider when collecting data for use in HRV analysis. In addition, the use of HRV analysis for the diagnosis of arrhythmias is discussed from human, small animal and equine perspectives. Finally, the future of HRV analysis is briefly introduced, including an overview of future developments in this rapidly expanding and exciting field.

Association Between Disease Severity, Heart Rate Variability (HRV) and Serum Cortisol Concentrations in Horses with Acute Abdominal Pain

Simple Summary

Acute abdominal pain is a major cause for emergency treatment in horses and associated with a high stress level leading to an increased serum cortisol concentration. Stress can also be assessed by analyzing the heart rate variability (HRV). We investigated whether the stress level was different between horses with different causes of abdominal pain and, therefore, demanding a different treatment strategy. Heart rate, its variability in the time domain analyses, and cortisol level indicated a decrease in the stress level the day after admission and the day of discharge from the hospital in comparison to admission for both conservatively and surgically treated patients. However, such changes, over time, were not seen in horses that were euthanized during the hospitalization. Furthermore, the difference in the parameters measured between horses that were eventually euthanized and those that survived was best visible the day after admission. Therefore, we concluded that HRV can give further important information on the stress level in horses with colic and might be helpful in assessing possible outcome. However, further studies are required to assess the validity of HRV analyses in horses with colic.

Abstract

Heart rate variability (HRV) is a noninvasive technique to detect changes in the autonomous nervous system. It has rarely been investigated in horses with colic. Therefore, the objective was to assess the evolution of HRV parameters and cortisol concentrations in horses with colic. The 43 horses included in this study were categorized into three groups according to the treatment (1, surgical; 2, conservative; 3, euthanized). The HRV and laboratory variables were measured at admission (T1), the day after admission (T2), and at discharge (T3) and compared between groups and over time with an ANOVA with Bonferroni correction. Relationships between the HRV parameters themselves and the laboratory variables was assessed by Pearson correlation coefficients. Evolution of the heart rate (HR) over time, mean normal to normal R intervals (meanNN) and cortisol concentrations indicate a decreased sympathetic stimulation over time in group 1 and 2, in contrast to group 3. For group 3, the meanNN and HR differed significantly to group 2 at T1 and to group 1 and 2 at T2. Treatment induced a change in the HRV and cortisol response in horses managed conservatively or surgically but not in horses that required euthanasia. However, further studies are required to assess the validity of HRV analyses in horses with colic.

Evaluation of Stress Response under a Standard Euthanasia Protocol in Horses Using Analysis of Heart Rate Variability

Simple Summary

In our study, we examined different stress factors during euthanasia in horses. Therefore, we measured the heart rate variability (HRV), which is a method to determine stress in various species. The HRV was determined in 40 horses undergoing euthanasia due to various reasons, at different times and locations throughout the clinic, and with/without owner presence. Significant differences in HRV parameters were found between the times of euthanasia. The location of euthanasia, presence of owner, or type of primary diseases had no influence on stress parameters. Horse with colic however presented with less smooth euthanasia. In conclusion, HRV is a sensitive, noninvasive parameter to assess the stress response during euthanasia. Further, euthanasia in horses with colic was the most challenging and modification of the protocols for colic horses should be considered.

Abstract

The effects of a standard protocol for euthanasia on heart rate variability (HRV) as a consequence of stress response were analyzed in this prospective clinical study. The HRV was determined in 40 horses undergoing euthanasia due to various reasons, at different locations, and with/without owner presence. For euthanasia, horses were sedated with xylazine or a combination of xylazine and butorphanol. General anesthesia was induced using diazepam and ketamine. Afterwards, horses were euthanized with pentobarbital. The ECG data were taken by a Telemetric ECG at three time points (sedation, anesthesia, anesthesia until death). The HRV was analyzed including the low (LF) and high frequency (HF) components of HRV and the sympathovagal balance (LF/HF ratio). Significant differences in the LF, HF and LF/HF ratio were found between the three time points of euthanasia (p < 0.001). The HRV analysis showed dominating sympathetic activity in the preparation phase of euthanasia and during the injection of pentobarbital. The location of euthanasia, presence of owner and type of primary diseases had no influence on stress parameters. Horses showing excitations or groaning during euthanasia did not differ in HRV. Horse with colic were however more likely to show reoccurrence of breathing during euthanasia. In conclusion, HRV is a sensitive, noninvasive parameter to obtain sympathovagal stimulations during euthanasia and adapted protocols for euthanasia in horse with colic should be studied.

The use of heart rate variability analysis to detect arrhythmias in horses undergoing a standard treadmill exercise test

Background

Little is known about normal heart rate variability (HRV) in horses during exercise. It can be difficult to separate premature beats from normal beat‐to‐beat variation at higher heart rates.

Objectives

The aim was to quantify HRV in healthy horses during a high‐speed treadmill‐standardized exercise test (HSET) and to compare with the HRV in horses observed to have arrhythmias during exercise.

Animals

Thirteen healthy horses (Group H), 30 horses with arrhythmias (Group A), and 11 horses with poor performance but no observed arrhythmias (Group O).

Methods

Prospective, observational study. All horses performed a HSET with simultaneous electrocardiograph (ECG) recorded. The ECGs were corrected for artifacts, and arrhythmias noted. Percent instantaneous beat‐to‐beat cycle length variation (% R‐R variation) was calculated, and HRV analyses were performed on trot, canter, and recovery segments.

Results

Group H showed between −4.4 and +3.8% R‐R variation during trot and between −6.1 and +5.4% R‐R variation during the canter phase of the HSET. Group A had significantly larger maximum and 1st percentile R‐R shortening and lengthening compared with Group H and Group O during the recovery phase where most arrhythmias were observed. During recovery, a cutoff of 6% maximum % R‐R shortening predicted the presence of arrhythmia with 88% sensitivity and 97% specificity and likelihood ratio of 26.

Conclusions and Clinical Importance

Healthy horses have little instantaneous R‐R variation during exercise. If a cardiac cycle shortens more than 6% from the previous cycle during the recovery phase, this R‐R interval is likely to represent an arrhythmic event.

Can heart rate variability parameters derived by a heart rate monitor differentiate between atrial fibrillation and sinus rhythm?

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.

Agreement between Electrocardiogram and Heart Rate Meter Is Low for the Measurement of Heart Rate Variability during Exercise in Young Endurance Horses

Analysis of the heart rate variability (HRV) gains more and more importance in the assessment of training practice and welfare in equine industry. It relies on mathematical analyses of reliably and accurately measured variations in successive inter-beat intervals, measured as RR intervals. Nowadays, the RR intervals can be obtained through two different techniques: a heart rate meter (HRM) or an electrocardiogram (ECG). The agreement and reliability of these devices has not been fully assessed, especially for recordings during exercise. The purpose of this study was to assess the agreement of two commercially available devices using the two mentioned techniques (HRM vs ECG) for HRV analysis during a standardized exercise test. Simultaneous recordings obtained during light exercise and during canter with both devices were available for 36 horses. Data were compared using a Bland–Altman analysis and the Lin’s coefficient. The agreement between the assessed HRV measures from the data obtained from the ECG and HRM was acceptable only for the mean RR interval and the mean heart rate. For the other studied measures (SDNN, root mean square of successive differences, SD1, SD2, low frequency, high frequency), the agreement between the devices was too poor for them to be considered as interchangeable in these recording conditions. The agreement tended also to be worse when speed of the exercise increased. Therefore, it is necessary to be careful when interpreting and comparing results of HRV analysis during exercise, as the results will depend upon recording devices. Furthermore, corrections and data processing included in the software of the devices affect largely the output used in the subsequent HRV analysis; this must be considered in the choice of the device.