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Buschmann E, Van Steenkiste G, Duytschaever M, Boussy T, Vernemmen I, Ibrahim L, Schauvliege S, Decloedt A, van Loon G. Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system. Equine Vet J 2024; 56:1068-1076. [PMID: 38151793 DOI: 10.1111/evj.14037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Recently, treatment of equine atrial tachycardia by three-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) has been described. Myocardial sleeves in the caudal vena cava and pulmonary veins are a potential trigger for initiation and perpetuation of atrial tachycardia and atrial fibrillation in the horse. Isolation of these myocardial sleeves by RFCA may be an effective treatment for these arrhythmias. OBJECTIVES To describe the feasibility of 3D EAM and RFCA to isolate caudal vena cava and pulmonary veins in adult horses using 3D mapping and a contact force (CF)-guided ablation system. STUDY DESIGN In vivo experiments. METHODS 3D EAM and RFCA was performed in five horses without cardiovascular disease under general anaesthesia, using the CF-guided system CARTO®3. Point-by-point RFCA aimed for isolation of caudal vena cava and pulmonary veins. Radiofrequency energy was delivered in power-controlled mode with a target power of 45 W, CF between 10 and 15 g and 30 mL/min irrigation rate, until an ablation-index of 450-500 was reached. RESULTS In the right atrium, myocardial sleeves of the caudal vena cava were isolated (n = 5). In the left atrium, isolation of ostium II (n = 3), ostium III (n = 1) and ostium I, II and III en bloc (n = 1) was performed. Successful isolation was confirmed by entrance and exit block. MAIN LIMITATIONS Horses were euthanised at the end of the procedure, so long term effects such as potential reconnection of isolated veins could not be studied. CONCLUSIONS This is the first description of 3D EAM and RFCA with CARTO®3 in horses, thereby showing the technical feasibility and successful caudal vena cava and pulmonary vein isolation. CF measurement allowed monitoring of catheter-tissue contact, resulting in efficient acute lesion creation as confirmed by entrance and exit block. This is a promising treatment for cardiac arrhythmias 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
| | - Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvliege
- Department of Large Animal Surgery, Anaesthesia and Orthopaedics, 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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Asorey I, Corletto F. Anaesthetic management of a horse with atrial fibrillation undergoing transvenous electrical cardioversion in combination with amiodarone. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Federico Corletto
- Dick White Referrals Six Mile Bottom UK
- Newmarket Equine Hospital Newmarket UK
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Van Steenkiste G, Boussy T, Duytschaever M, Vernemmen I, Schauvlieghe S, Decloedt A, van Loon G. Detection of the origin of atrial tachycardia by 3D electro-anatomical mapping and treatment by radiofrequency catheter ablation in horses. J Vet Intern Med 2022; 36:1481-1490. [PMID: 35686355 PMCID: PMC9308432 DOI: 10.1111/jvim.16473] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Atrial tachycardia (AT) can be treated by medical or electrical cardioversion but the recurrence rate is high. Three-dimensional electro-anatomical mapping, recently described in horses, might be used to map AT to identify a focal source or reentry mechanism and to guide treatment by radiofrequency ablation. OBJECTIVES To describe the feasibility of 3D electro-anatomical mapping and radiofrequency catheter ablation to characterize and treat sustained AT in horses. ANIMALS Nine horses with sustained AT. METHODS Records from horses with sustained AT referred for radiofrequency ablation at Ghent University were reviewed. RESULTS The AT was drug resistant in 4 out of 9 horses. In 8 out of 9 horses, AT originated from a localized macro-reentrant circuit (n = 5) or a focal source (n = 3) located at the transition between the right atrium and the caudal vena cava. In these 8 horses, local radiofrequency catheter ablation resulted in the termination of AT. At follow-up, 6 out of 8 horses remained free of recurrence. CONCLUSIONS AND CLINICAL IMPORTANCE Differentiation between focal and macro-reentrant AT in horses is possible using 3D electro-anatomical mapping. In this study, the source of right atrial AT in horses was safely treated by radiofrequency catheter ablation.
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Affiliation(s)
- Glenn Van Steenkiste
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium
| | | | - Ingrid Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Stijn Schauvlieghe
- Department of Surgery and Anaesthesiology of Domestic Animals, Ghent University, Merelbeke, Belgium
| | - Annelies Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium
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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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Premont A, Balthes S, Marr CM, Jeevaratnam K. Fundamentals of arrhythmogenic mechanisms and treatment strategies for equine atrial fibrillation. Equine Vet J 2021; 54:262-282. [PMID: 34564902 DOI: 10.1111/evj.13518] [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: 12/21/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
Atrial fibrillation (AF) is the most common pathological arrhythmia in horses. Although it is not usually a life-threatening condition on its own, it can cause poor performance and make the horse unsafe to ride. It is a complex multifactorial disease influenced by both genetic and environmental factors including exercise training, comorbidities or ageing. The interactions between all these factors in horses are still not completely understood and the pathophysiology of AF remains poorly defined. Exciting progress has been recently made in equine cardiac electrophysiology in terms of diagnosis and documentation methods such as cardiac mapping, implantable electrocardiogram (ECG) recording devices or computer-based ECG analysis that will hopefully improve our understanding of this disease. The available pharmaceutical and electrophysiological treatments have good efficacy and lead to a good prognosis for AF, but recurrence is a frequent issue that veterinarians have to face. This review aims to summarise our current understanding of equine cardiac electrophysiology and pathophysiology of equine AF while providing an overview of the mechanism of action for currently available treatments for equine AF.
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Affiliation(s)
- Antoine Premont
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Samantha Balthes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Celia M Marr
- Rossdales Equine Hospital and Diagnostic Centre, Newmarket, UK
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Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021; 11:ani11061777. [PMID: 34198637 PMCID: PMC8232193 DOI: 10.3390/ani11061777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions. Abstract Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.
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Van Steenkiste G, Carlson J, Decloedt A, Vera L, Buhl R, Platonov PG, van Loon G. Relationship between atrial fibrillatory rate based on analysis of a modified base-apex surface electrocardiogram analysis and the results of transvenous electrical cardioversion in horses with spontaneous atrial fibrillation. J Vet Cardiol 2021; 34:73-79. [PMID: 33611234 DOI: 10.1016/j.jvc.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the atrial fibrillatory rate (AFR) derived from a local right atrial intracardiac recording (RA-FR) and from a single-lead surface electrocardiogram (ECG) during atrial fibrillation (AF) and to evaluate the correlation with transvenous electrical cardioversion (TVEC) threshold (in Joules), number of shocks and cardioversion success rate in horses. ANIMALS ECGs and clinical records of horses with AF treated by TVEC. Horses were included if a simultaneous recording of the right atrial intracardiac electrogram and a modified base-apex ECG were available. MATERIALS AND METHODS Clinical records of horses with AF treated by TVEC were reviewed. Three-minute long episodes of simultaneous electrograms and surface ECG during AF were selected for analysis and compared using Bland-Altman analysis. The mean RA-FR was measured from the deflections on the intracardiac electrogram, while the AFR was extracted from the surface ECG using spatiotemporal QRS and T-wave cancellation. RESULTS Seventy-three horses satisfied the inclusion criteria. The mean difference between RA-FR and AFR was -13 fibrillations per minute (fpm), the 95% limits of agreement were between -66 and 40 fpm, and there was a moderate (ρ = 0.65) correlation between RA-FR and AFR (p < 0.001). Neither RA-FR nor AFR appeared to influence the TVEC cardioversion threshold or the number of TVEC shocks applied. CONCLUSIONS The AFR may allow non-invasive long-term monitoring of AF dynamics. Neither RA-FR nor AFR could be used to predict the minimal defibrillation threshold for TVEC.
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Affiliation(s)
- G Van Steenkiste
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - J Carlson
- Department of Cardiology, Lund University, 21185 Lund, Sweden
| | - A Decloedt
- 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
| | - R Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, 2630 Taastrup, Denmark
| | - P G Platonov
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, 21185 Lund, Sweden
| | - 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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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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Abstract
Arrhythmias are common in horses. Sinus arrhythmia and first- and second-degree atrioventricular block are frequently found physiologic arrhythmias, but should immediately disappear after stress or exercise. Atrial premature depolarizations are usually not associated with poor performance, but are a potential trigger for atrial fibrillation. Atrial fibrillation results in an abnormal ventricular response during exercise and poses a risk for collapse in some horses. This arrhythmia can usually be treated by quinidine sulfate or transvenous electrical cardioversion. Ventricular premature depolarizations, especially when associated with structural heart disease, may be a risk factor for ventricular tachycardia or even ventricular fibrillation.
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Affiliation(s)
- Gunther van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
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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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Decloedt A, Broux B, De Clercq D, Deprez P, Van Steenkiste G, Vera L, Ven S, van Loon G. Effect of sotalol on heart rate, QT interval, and atrial fibrillation cycle length in horses with atrial fibrillation. J Vet Intern Med 2018; 32:815-821. [PMID: 29460446 PMCID: PMC5866983 DOI: 10.1111/jvim.15055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/04/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022] Open
Abstract
Background Based on its pharmacokinetic profile and electrophysiological effects in healthy horses, sotalol potentially could be used as a long‐term PO antiarrhythmic drug in horses. Objectives To evaluate the effect of sotalol on heart rate (HR), QT interval, atrial fibrillatory rate, and success of cardioversion in horses with naturally occurring chronic atrial fibrillation (AF). Animals Twenty‐eight horses referred for transvenous electrical cardioversion of AF were treated with 2 mg/kg sotalol PO q12h for 3 days before cardioversion, and 13 horses underwent the same protocol without sotalol administration. Methods Retrospective study. Before and after sotalol or no treatment, the HR was measured at rest and during an exercise test. The QT interval and atrial fibrillation cycle length (AFCL) were measured at rest using tissue Doppler velocity imaging. Results In the control group, no significant differences were found between the 2 examinations. In the sotalol group, the HR at rest and during exercise was significantly lower after sotalol treatment, whereas the QT interval and AFCL measured by tissue Doppler increased significantly. Cardioversion to sinus rhythm was achieved in 25/28 horses in the sotalol group and all horses in the control group, but the median number of shocks and energy at cardioversion were significantly lower in the sotalol group. Conclusions and Clinical Importance In horses with AF, sotalol administration results in class III antiarrhythmic effects and β‐blocking activity, with moderate HR reduction during exercise.
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Affiliation(s)
- Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Barbara Broux
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Dominique De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Piet Deprez
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Glenn Van Steenkiste
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Lisse Vera
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Sofie Ven
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - Gunther van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
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12
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Gozalo-Marcilla M, Gasthuys F, Luna SPL, Schauvliege S. Is there a place for dexmedetomidine in equine anaesthesia and analgesia? A systematic review (2005-2017). J Vet Pharmacol Ther 2017; 41:205-217. [PMID: 29226340 DOI: 10.1111/jvp.12474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
The objective of this review was to perform a literature compilation of all the equine publications that used dexmedetomidine as the first article on this topic was published, in 2005. We also aimed to answer the question whether the use of dexmedetomidine can currently be justified. For that, we compiled information from databases, such as PubMed, Google Scholar and Web of Science and the proceedings of the last veterinary anaesthesiology meetings. Dexmedetomidine is an attractive drug to be used in horses, mainly due to its pharmacokinetic profile and pharmacodynamics that favour its use as intravenous constant rate infusion (CRI). Nowadays, its clinical use is popular for sedation in prolonged standing procedures and during partial intravenous anaesthesia (PIVA) and total intravenous anaesthesia (TIVA). However, legal requirements for its use should be taken into account.
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Affiliation(s)
- M Gozalo-Marcilla
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - F Gasthuys
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - S P L Luna
- Department of Veterinary Surgery and Anaesthesiology, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - S Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Whelchel DD, Tennent-Brown BS, Coleman AE, Rapoport GS, Blas-Machado U, Maisenbacher HW, Credille BC, Giguère S. Treatment of supraventricular tachycardia in a horse. J Vet Emerg Crit Care (San Antonio) 2017; 27:362-368. [DOI: 10.1111/vec.12591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/23/2015] [Accepted: 08/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Brett S. Tennent-Brown
- Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee VIC 3030 Australia
| | - Amanda E. Coleman
- College of Veterinary Medicine; University of Georgia; Athens GA 30602
| | - Gregg S. Rapoport
- College of Veterinary Medicine; University of Georgia; Athens GA 30602
| | | | | | | | - Steeve Giguère
- College of Veterinary Medicine; University of Georgia; Athens GA 30602
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14
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Topography and ultrasonographic identification of the equine pulmonary vein draining pattern. Vet J 2016; 210:17-23. [DOI: 10.1016/j.tvjl.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/03/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022]
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Decloedt A, de Clercq D, Ven S, van der Vekens N, Chiers K, van Loon G. Right atrial and right ventricular ultrasound-guided biopsy technique in standing horses. Equine Vet J 2015; 48:346-51. [DOI: 10.1111/evj.12433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/09/2015] [Indexed: 12/26/2022]
Affiliation(s)
- A. Decloedt
- 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
| | - S. Ven
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - N. van der Vekens
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - K. Chiers
- Department of Pathology, Bacteriology and Poultry Diseases; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
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Decloedt A, Schwarzwald CC, De Clercq D, Van Der Vekens N, Pardon B, Reef VB, van Loon G. Risk factors for recurrence of atrial fibrillation in horses after cardioversion to sinus rhythm. J Vet Intern Med 2015; 29:946-53. [PMID: 25917409 PMCID: PMC4895430 DOI: 10.1111/jvim.12606] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 02/13/2015] [Accepted: 03/31/2015] [Indexed: 11/29/2022] Open
Abstract
Background Although atrial fibrillation (AF) can be successfully treated in horses, recurrence occurs frequently. In humans, atrial function after cardioversion can predict recurrence. Objectives To examine the prognostic value of atrial mechanical function at 24 hours after cardioversion and other potential predictor variables for AF recurrence in horses. Animals 117 horses treated for AF at 4 referral centers. Methods Retrospective study. Inclusion criteria were successful cardioversion, echocardiography at 24 hours after cardioversion and ≥4 months follow‐up. To determine factors associated with AF recurrence, a multivariable survival model was built. Results 133 AF episodes in 117 horses were included. AF recurred in 36/100 horses with a first AF episode and in 57/133 AF episodes overall. Factors associated with recurrence in horses with a first episode were previous unsuccessful treatment attempt (hazard ratio HR 2.36, 95% confidence interval CI 1.11–4.99, P = .025) and mild or moderate mitral regurgitation (HR 2.70, 95% CI 1.23–5.91, P = .013). When the last AF episode of all horses was included, previous AF (HR 2.53, 1.33–4.82, P = .005) and active left atrial fractional area change ≤9.6% (HR 3.43, 1.22–9.67, P = .020) were significant predictors. Conclusions and Clinical Importance The only echocardiographic variable of left atrial function with significant prognostic value for recurrence was low active left atrial fractional area change. Further research is necessary to evaluate whether echocardiography at a later timepoint could provide more prognostic information.
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Affiliation(s)
- A Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - C C Schwarzwald
- Clinic for Equine Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, 8057, Switzerland.,Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - D De Clercq
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - N Van Der Vekens
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - B Pardon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
| | - V B Reef
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, 19348
| | - G van Loon
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, 9820, Belgium
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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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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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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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Decloedt A, de Clercq D, van der Vekens N, Verheyen T, van Loon G. Noninvasive determination of atrial fibrillation cycle length by atrial colour tissue Doppler imaging in horses. Equine Vet J 2013; 46:174-9. [PMID: 23738919 DOI: 10.1111/evj.12108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Atrial fibrillation cycle length (AFCL) is an indicator of atrial electrical remodelling during atrial fibrillation (AF). OBJECTIVES To compare AFCL measured invasively from an intra-atrial electrogram (AFCLEGM ) with AFCL measured noninvasively by atrial colour tissue Doppler imaging (AFCLTDI ). STUDY DESIGN Prospective descriptive clinical study. METHODS Measurements were performed in 31 episodes of AF or flutter in 29 horses (588 ± 61 kg bwt, 9 ± 3 years old) admitted for transvenous electrical cardioversion. The AFCLEGM was measured from an intracardiac electrogram using a bipolar sensing/pacing electrode inserted into the right atrium. The AFCLTDI was measured from atrial colour tissue velocity curves in the following 5 regions: 1) left atrial free wall from a right parasternal 4-chamber view, 2) left atrial free wall from a short-axis view, 3) left atrial free wall from a left parasternal long-axis view, 4) interatrial septum, and 5) right atrial dorsal wall near the tuberculum intervenosum. The AFCLEGM and AFCLTDI from the 5 regions were compared using a one-way repeated-measures ANOVA with Bonferroni correction for multiple comparisons and calculation of the Bland-Altman mean bias and limits of agreement of AFCLEGM and AFCLTDI . RESULTS The AFCLEGM was 161 ± 18 ms in 29 AF episodes. Two horses showed atrial flutter and had an AFCLEGM of 244 and 324 ms. The mean bias between AFCLTDI and AFCLEGM ranged from -18 to +9 ms depending on the atrial wall region. The AFCLTDI was significantly shorter in the left atrial free wall from the right parasternal 4-chamber view and short-axis view than in the other regions (P<0.001). CONCLUSIONS Tissue Doppler imaging allows noninvasive measurement of AFCL in horses with AF and is able to identify spatial differences within the equine atria. Atrial fibrillation cycle length is an indicator of atrial electrical remodelling and is an important parameter to study AF pathophysiology or the effect of antiarrhythmic drugs.
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Affiliation(s)
- A Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Belgium
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Decloedt A, Verheyen T, Van Der Vekens N, Sys S, De Clercq D, van Loon G. Long-term follow-up of atrial function after cardioversion of atrial fibrillation in horses. Vet J 2013; 197:583-8. [PMID: 23823082 DOI: 10.1016/j.tvjl.2013.05.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 05/21/2013] [Accepted: 05/22/2013] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation (AF) causes atrial electrical and contractile remodelling in horses. The aim of this study was to quantify left atrial (LA) contractile function and its time course of recovery after cardioversion of naturally-occurring AF in horses. The study population included 42 AF horses which were successfully treated using transvenous electrical cardioversion TVEC (n=39) or quinidine sulfate (n=3), with trivial or mild mitral regurgitation present in 25 horses. Thirty-seven healthy horses were used as controls. AF duration was estimated based on the history and previous examinations. Echocardiography was performed during general anaesthesia after TVEC (day 0) and on days 1, 2, 6 and then 7 weeks after cardioversion. The two-dimensional (2D) echocardiographic measurements included LA diameter, area and ejection phase indices such as fractional shortening. Atrial TDI measurements included peak myocardial velocity during atrial contraction (A), time to onset A, time to peak A and duration of A. During follow-up after cardioversion, atrial contractile function measured by 2D echocardiography and TDI gradually improved. At 7 weeks following cardioversion, TDI-based myocardial velocities returned to reference values. However, AF horses still showed significantly larger atrial dimensions, lower 2D ejection phase indices and prolonged TDI-based conduction time compared to the control group. In conclusion, AF-induced atrial contractile dysfunction gradually improves in the weeks following cardioversion, but at 7 weeks post-cardioversion, significant differences remain compared to healthy controls.
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Affiliation(s)
- Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
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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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