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Buhl R, Hesselkilde EM, Carstensen H, Hopster‐Iversen C, van Loon G, Decloedt A, Van Steenkiste G, Marr C, Reef VB, Schwarzwald CC, Mitchell KJ, Nostell K, Nogradi N, Nielsen SS, Carlson J, Platonov P. Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion. Equine Vet J 2022; 54:1013-1022. [PMID: 34957586 PMCID: PMC9787611 DOI: 10.1111/evj.13551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The recurrence rate of atrial fibrillation (AF) in horses after cardioversion to sinus rhythm (SR) is relatively high. Atrial fibrillatory rate (AFR) derived from surface ECG is considered a biomarker for electrical remodelling and could potentially be used for the prediction of successful AF cardioversion and AF recurrence. OBJECTIVES Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. STUDY DESIGN Retrospective multicentre study. METHODS Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. Bipolar surface ECG recordings were analysed by spatiotemporal cancellation of QRST complexes and calculation of AFR from the remaining atrial signal. Kaplan-Meier survival curve and Cox regression analyses were performed to assess the relationship between AFR and the risk of AF recurrence. RESULTS Of the 195 horses included, 74 received quinidine treatment and 121 were treated with TVEC. Ten horses did not cardiovert to SR after quinidine treatment and AFR was higher in these, compared with the horses that successfully cardioverted to SR (median [interquartile range]), (383 [367-422] vs 351 [332-389] fibrillations per minute (fpm), P < .01). Within the first 180 days following AF cardioversion, 12% of the quinidine and 34% of TVEC horses had AF recurrence. For the horses successfully cardioverted with TVEC, AFR above 380 fpm was significantly associated with AF recurrence (hazard ratio = 2.4, 95% confidence interval 1.2-4.8, P = .01). MAIN LIMITATIONS The treatment groups were different and not randomly allocated, therefore the two treatments cannot be compared. Medical records and the follow-up strategy varied between the centres. CONCLUSIONS High AFR is associated with failure of quinidine cardioversion and AF recurrence after successful TVEC. As a noninvasive marker that can be retrieved from surface ECG, AFR can be clinically useful in predicting the probability of responding to quinidine treatment as well as maintaining SR after electrical cardioversion.
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Affiliation(s)
- Rikke Buhl
- Department of Veterinary Clinical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Eva M. Hesselkilde
- Department of Veterinary Clinical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Helena Carstensen
- Department of Veterinary Clinical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Charlotte Hopster‐Iversen
- Department of Veterinary Clinical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Gunther van Loon
- Equine CardioteamDepartment of Large Animal Internal MedicineGhent UniversityMerelbekeBelgium
| | - Annelies Decloedt
- Equine CardioteamDepartment of Large Animal Internal MedicineGhent UniversityMerelbekeBelgium
| | - Glenn Van Steenkiste
- Equine CardioteamDepartment of Large Animal Internal MedicineGhent UniversityMerelbekeBelgium
| | | | - Virginia B. Reef
- Department of Clinical Studies New Bolton CenterUniversity of Pennsylvania School of Veterinary MedicineKennett SquarePennsylvaniaUSA
| | | | | | - Katarina Nostell
- Department of Clinical SciencesFaculty of Veteirnary SciencesSwedish University of Agricultural SciencesUppsalaSweden
| | | | - Søren S. Nielsen
- Department of Veterinary SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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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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Phillips V, Schauvliege S, Decloedt A, Van Steenkiste G, van Loon G. Anaesthetic management for cardiac 3D electro‐anatomical mapping and radiofrequency catheter ablation in a horse with sustained atrial tachycardia. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Phillips
- Willows Veterinary Centre and Referral Service Highlands Road Shirley UK
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals 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
| | - Glenn Van Steenkiste
- 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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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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Catheter-based electrical interventions to study, diagnose and treat arrhythmias in horses: From refractory period to electro-anatomical mapping. Vet J 2020; 263:105519. [PMID: 32928488 DOI: 10.1016/j.tvjl.2020.105519] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022]
Abstract
Minimally-invasive catheter-based interventional cardiology is a mainstay for the diagnosis and treatment of arrhythmias in human medicine. Very accurate imaging using fluoroscopy, CT and MRI is essential during interventional cardiology procedures. Because these imaging techniques are either not possible or provide too little anatomical detail in horses, echocardiography is currently the best technique to visualize catheters in horses. Over the past decades, catheter-based techniques have been applied to induce arrhythmias using pacing and to perform arrhythmia research using electrophysiological studies. In bradycardic animals with clinical signs, permanent pacing can be achieved by pacemaker implantation via the cephalic vein. Transvenous electrical cardioversion, based on one cardioversion catheter in the pulmonary artery and one in the right atrium, has become the treatment of choice for atrial fibrillation in horses, even for longstanding or drug-resistant atrial fibrillation. Recently, the highly advanced technique of three dimensional electroanatomical mapping has been described in horses. This technique has not only revealed essential electrophysiological data in horses, but has also facilitated the successful ablation of atrial tachycardia in horses.
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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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Koenig TR, Mitchell KJ, Schwarzwald CC. Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging. J Vet Intern Med 2017; 31:556-567. [PMID: 28109132 PMCID: PMC5354014 DOI: 10.1111/jvim.14641] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/14/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. Objectives To describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. Animals Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Methods Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test. Results A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (−2.6 [−4.7 to −0.5] cm/s), Em (−14.2 [−19.9 to −8.5] cm/s), and Em/Am ratio (−1.6 [−2.6 to −0.6]). Conclusions and Clinical Importance Pulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.
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Affiliation(s)
- T R Koenig
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K J Mitchell
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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