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Köster LS, Zhu X, Smith CK, Aisa J. Single center retrospective clinical audit and comparison of outcome between epicardial and transvenous endocardial permanent pacemaker implantations in dogs. PLoS One 2023; 18:e0290029. [PMID: 38015932 PMCID: PMC10683988 DOI: 10.1371/journal.pone.0290029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
The aim of this retrospective cohort study was to provide a single-center clinical audit of complications for single chamber permanent pacemaker implantation (PPI) techniques and determine if the clinical parameters, PPI technique or complications were associated with outcome. The electronic medical records were searched for dogs treated for bradyarrhythmia with PPI. Data related to presenting complaint, signalment of the dog, ECG diagnosis, echocardiographic findings, PPI technique, and programing of the pacemaker were recorded. Survival length (days) was recorded as the last veterinary visit; if the dog was dead the reason was documented. Cumulative survival of each pacemaker was examined by a Kaplan-Meier survival curve and the two techniques compared with a logrank test. Chi-square was used to determine the association between major complications and death. A total of 66 dogs with 52 transvenous and 30 epicardial PPIs were included. All epicardial pacemakers were implanted via transdiaphragmatic approach. A total of 31 life-threatening complications were reported. There were nine deaths related to major complications (13.6% of the study sample). The median follow-up period was 366 days, with a median survival of 255 days, and a significant difference in cumulative survival of each pacemaker (P = 0.01) between epicardial (93 days, range 0-1882 days) and transvenous (334 days, range 0-2745) PPIs but no significant difference in cumulative survival between the two techniques when only the first pacemaker was considered (p = 0.07). The presence of a major complications had a significant association with death due to pacemaker complications (P<0.001). The decision to perform epicardial PPI in failed transvenous PPI patients may have skewed the cumulative survival as was evident in the lack of significant difference in survival when only first PPI were examined. Major complication rates between the two techniques were similar and the authors consider both techniques equally reliable to manage symptomatic bradycardia in dogs.
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Affiliation(s)
- Liza S. Köster
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
| | - Xiaojuan Zhu
- Office of Information Technology, University of Tennessee, Knoxville, TN, United States of America
| | - Christopher K. Smith
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
| | - Josep Aisa
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
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Sanz-Gonzalez I, Aitken J, Pedro B, Martin M, Martinez Pereira Y, Dukes-McEwan J, Bode EF, Culshaw GJ. Clinical presentation, management, and survival in dogs with persistent atrial standstill in the United Kingdom. J Vet Cardiol 2023; 51:179-187. [PMID: 38150959 DOI: 10.1016/j.jvc.2023.11.016] [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: 11/14/2022] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
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.
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Affiliation(s)
- I Sanz-Gonzalez
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom.
| | - J Aitken
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Building 400, Parkville, Victoria, 3052, Australia
| | - B Pedro
- Centro de Cardiologia Veterinaria do Porto, Rua Artur Maia Mendes 93, 4250-068, Porto, Portugal
| | - M Martin
- Veterinary Cardiology Consultancy, Kenilworth, CV8 2AA, United Kingdom
| | - Y Martinez Pereira
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom
| | - J Dukes-McEwan
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom; ChesterGates Veterinary Specialists, Telford Court, Gates Lane, Chester, Cheshire, CH1 6LT, United Kingdom
| | - G J Culshaw
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom
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Sudunagunta S, Hamilton-Elliott J, Dukes-McEwan J. Mitral valve dysplasia in eight English Springer Spaniels. J Vet Cardiol 2020; 33:52-60. [PMID: 33360833 DOI: 10.1016/j.jvc.2020.11.003] [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: 07/30/2019] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To describe the signalment, physical examination, and echocardiographic findings of a series of English Springer Spaniels (ESSs) diagnosed with congenital mitral valve dysplasia (MD). ANIMALS Eight client-owned ESSs with congenital MD referred for murmur investigation and/or suspected congestive heart failure (CHF). MATERIALS AND METHODS Retrospective case series. Medical records and echocardiograms were reviewed to collect relevant data. Echocardiograms were assessed for the following abnormalities consistent with MD: thickened valve leaflets or leaflet tips, a 'hockey stick' appearance to the valve leaflets, abnormal length of one leaflet with respect to the other, and tethering of one or both leaflets to the papillary muscles. RESULTS All eight dogs showed the typical echocardiographic lesions associated with MD: thickened leaflet tips (5/8), 'hockey stick' appearance (5/8), elongated anterior leaflet (4/8), tethering of one or both leaflets (7/8). Seven of the eight dogs presented in CHF. Six of the eight dogs had left ventricular dilation in both systole and diastole. Two of the eight dogs had reduced systolic function as assessed by ejection fraction/fractional shortening; however end-systolic volume index was increased in 6/8 dogs. Two dogs subsequently developed atrial fibrillation. CONCLUSIONS Congenital MD should be considered in ESSs with a left-sided apical systolic murmur, particularly in younger dogs. The valve changes seen are similar to those reported in other breeds with MD (thickened leaflet tips, hockey stick appearance to open leaflet tips, abnormal leaflet tethering, abnormally shaped leaflets) and may result in marked remodeling and CHF.
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Affiliation(s)
- S Sudunagunta
- Cardiology Service, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK.
| | - J Hamilton-Elliott
- Cardiology Service, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - J Dukes-McEwan
- Cardiology Service, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
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Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Histological and morphometric study of the components of the sinus and atrioventricular nodes in horses and dogs. Res Vet Sci 2019; 126:22-28. [DOI: 10.1016/j.rvsc.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/20/2019] [Accepted: 08/02/2019] [Indexed: 12/26/2022]
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Ward J, McLaughlin A, Burzette R, Keene B. The effect of a surgical safety checklist on complication rates associated with permanent transvenous pacemaker implantation in dogs. J Vet Cardiol 2019; 22:72-83. [DOI: 10.1016/j.jvc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/09/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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Indications for permanent pacing in dogs and cats. J Vet Cardiol 2019; 22:20-39. [PMID: 30709617 PMCID: PMC7185536 DOI: 10.1016/j.jvc.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022]
Abstract
Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.
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Considerations for analysis of time-to-event outcomes subject to competing risks in veterinary clinical studies. J Vet Cardiol 2018; 20:143-153. [DOI: 10.1016/j.jvc.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/28/2018] [Accepted: 03/15/2018] [Indexed: 12/19/2022]
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