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Kutinsky I, Duncan A, Danforth MD, Murray S, Napier J, McCain S, Murphy HW. Surgical placement of implantable cardiac loop recorders in great apes. Am J Primatol 2023; 85:e23471. [PMID: 36720698 DOI: 10.1002/ajp.23471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 12/31/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023]
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in zoologically managed adult great apes, accounting for 29%-77% of adult deaths in the North American population depending on the species. In an effort to better understand the underlying causes of heart disease, implantable loop recorders (ILRs) have been used in some cases to monitor great apes with suspected or known cases of arrhythmia. This is a 10-year review of the Great Ape Heart Project's experience of implanting 21 ILRs in 7 gorillas (Gorilla gorilla gorilla; 9 total ILR devices), 5 chimpanzees (Pan troglodytes, 11 total ILR devices), and 1 orangutan (Pongo abelii, 1 ILR device) in an effort to develop effective methods for surgical implantation and remote collection of the data for analysis.
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Affiliation(s)
- Ilana Kutinsky
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ann Duncan
- Detroit Zoological Society, Royal Oak, Michigan, USA
| | - Marietta D Danforth
- Great Ape Heart Project, Detroit Zoological Society, Royal Oak, Michigan, USA.,Formerly Zoo Atlanta, Atlanta, Georgia, USA
| | - Suzan Murray
- Smithsonian's National Zoo and Conservation Biology Institute, Washington, USA
| | - Julie Napier
- Formerly Omaha's Henry Doorly Zoo and Aquarium, Omaha, Nebraska, USA
| | | | - Hayley W Murphy
- Great Ape Heart Project, Detroit Zoological Society, Royal Oak, Michigan, USA.,Formerly Zoo Atlanta, Atlanta, Georgia, USA
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Buhl R, Hesselkilde EM, Carstensen H, Fenner MF, Jespersen T, Tfelt‐Hansen J, Michael Sattler S. Detection of atrial fibrillation with implantable loop recorders in horses. Equine Vet J 2021; 53:397-403. [PMID: 32506470 PMCID: PMC7891449 DOI: 10.1111/evj.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/16/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiac arrhythmias in horses are diagnosed by auscultation or electrocardiogram (ECG), which results in a low sensitivity for detecting arrhythmias that occur sporadically. Implantable loop recorders (ILRs) are small ECG devices placed subcutaneously, to automatically detect arrhythmias in human patients. OBJECTIVES To test ILRs ability to detect atrial fibrillation (AF) in horses. Furthermore, we hypothesised that anatomical location of the implant site might influence signal quality. Signal quality was evaluated both during exercise and over time. STUDY DESIGN Experimental study. METHODS In five Standardbred mares, eleven ILRs were implanted subcutaneously in up to three different positions (Front: pectoral region, Left-6: sixth left intercostal space and Ventral: xiphoid region) and AF induced. The R- and T-wave amplitudes were measured in all positions over time during AF. AF burden automatically registered by the ILRs over a 2-month period was compared with selected Holter ECG recordings. RESULTS All three positions had stable R- and T-wave amplitudes during the study period and were of sufficient quality to allow AF detection at rest. The position Left-6 showed significantly higher R- and T-wave amplitudes compared with the other positions. During submaximal exercise only the Left-6 position was able to record ECG signals of diagnostic quality. No position yielded diagnostic signals at maximum exercise due to artefacts. MAIN LIMITATIONS Few horses and ILRs included and no spontaneous AF episodes were studied. CONCLUSIONS This preliminary study indicates that ILRs can be used for AF detection in horses, but the anatomical location is important for optimal ECG quality. Despite insufficient quality during exercise, ILRs were suitable for AF detection at rest. Therefore, the ILR may be a valuable diagnostic tool for detecting paroxysmal AF in horses.
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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
| | - Merle F. Fenner
- Department of Veterinary Clinical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Thomas Jespersen
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Jacob Tfelt‐Hansen
- Department of CardiologyThe Heart CentreCopenhagen University HospitalCopenhagenDenmark
- Department of Forensic MedicineFaculty of Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Stefan Michael Sattler
- Department of Biomedical SciencesFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyThe Heart CentreCopenhagen University HospitalCopenhagenDenmark
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Perego M, Porteiro Vàzquez DM, Ramera L, Lombardo SF, Pane C, Bontempi LV, Santilli RA. Heart rhythm characterisation during unexplained transient loss of consciousness in dogs. Vet J 2020; 263:105523. [PMID: 32928492 DOI: 10.1016/j.tvjl.2020.105523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
The identification of the heart rhythm during an episode of transient loss of consciousness (TLOC) is considered the reference standard method to elucidate the underlying aetiology. This study aimed to characterise heart rhythm in dogs during TLOC using Holter and external loop recorder monitoring. We retrospectively reviewed 24-h Holter monitoring and external loop recorder tracings from 8084 dogs. Heart rhythms from dogs that experienced TLOC during the recording was analysed to identify rhythm disturbances that occurred during episodes of TLOC. Electrocardiograms (ECGs) were subsequently categorised into Type 1 (ventricular arrest), Type 2 (sinus bradycardia), Type 3 (no/slight rhythm variations), and Type 4 (tachycardia). Transient LOC was documented in 92 dogs over 230 episodes of TLOC. Percentage of cases with ECGs compatible with each classification were as follows: 72.1%, Type 1; 6.1%, Type 2; 20.9%, Type 3; and 0.9%, Type 4. Cardiac rhythm during the TLOC could have been a consequence of a neurocardiogenic mechanism in 46.7% cases, while intrinsic rhythm disturbances of the sinus node or of the atrioventricular node were diagnosed in 31.5% cases. In two cases, tachycardia was the possible cause of the TLOC. ECG patterns in dogs presenting with multiple TLOC episodes were completely reproducible during each episode. TLOC in dogs was primarily caused by ventricular arrest. Most dogs with TLOC had electrocardiographic finding suggestive of a reflex or neurally-mediated syncope, but one third had an ECG more suggestive of a conduction disorder. Distinguishing these two entities could help inform diagnostic, therapeutic, and prognostic plans.
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Affiliation(s)
- M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Ospedale Veterinario I Portoni Rossi, Via Roma 57, 40069, Zola Predosa, Bologna, Italy
| | | | - L Ramera
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - S F Lombardo
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Ospedale Veterinario I Portoni Rossi, Via Roma 57, 40069, Zola Predosa, Bologna, Italy
| | - C Pane
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - L V Bontempi
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy
| | - R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017, Samarate, Varese, Italy; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA.
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Santilli RA, Giacomazzi F, Porteiro Vázquez DM, Perego M. 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] [MESH Headings] [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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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy; Department of Clinical Sciences, Cornell University, Ithaca, NY, USA.
| | - F Giacomazzi
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | | | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
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Lichtenberger J, Meurs KM, Côté E. Preliminary Assessment of a Novel 14-Day Electrocardiographic Adhesive Patch Monitor in Dogs. J Am Anim Hosp Assoc 2018; 54:138-143. [PMID: 29558214 DOI: 10.5326/jaaha-ms-6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac arrhythmias often are transient and might not be detected using conventional electrocardiographic (ECG) techniques. The adhesive patch monitor (APM) is a single-lead, lightweight, up to 14-day continuous ambulatory ECG monitor. This study aimed to prospectively assess its usability in four boxer dogs considered either to be healthy or to have arrhythmogenic right ventricular cardiomyopathy. Optimal recording was obtained by placing the APM on the left side of the animal's thorax, at the fifth intercostal space, slightly dorsal to the costochondral junction, and oriented either vertically or parallel to the long axis of the heart. In three dogs, the APM remained attached for 14 days. One dog removed the APM after 59 hr. Skin irritation was documented in all dogs and resolved spontaneously after removal of the APM. The analyzable time was >93% of the total wear time and recordings provided an unambiguous rhythm diagnosis at rest. Walking, running, or playing caused intermittent motion artifact that could impair ECG interpretation. APM results were comparable to those obtained with 24-hr Holter monitoring. Extended continuous ECG monitoring with the APM is feasible in boxer dogs and provides interpretable recordings.
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Affiliation(s)
- Jonathan Lichtenberger
- From the Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.L., E.C.); and the Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, North Carolina (K.M.M.)
| | - Kathryn M Meurs
- From the Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.L., E.C.); and the Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, North Carolina (K.M.M.)
| | - Etienne Côté
- From the Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (J.L., E.C.); and the Department of Veterinary Clinical Sciences, North Carolina State University, Raleigh, North Carolina (K.M.M.)
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Rasmussen CE, Falk T, Domanjko Petrič A, Schaldemose M, Zois NE, Moesgaard SG, Ablad B, Nilsen HY, Ljungvall I, Höglund K, Häggström J, Pedersen HD, Bland JM, Olsen LH. Holter monitoring of small breed dogs with advanced myxomatous mitral valve disease with and without a history of syncope. J Vet Intern Med 2014; 28:363-70. [PMID: 24417236 PMCID: PMC4857997 DOI: 10.1111/jvim.12290] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 10/08/2013] [Accepted: 11/26/2013] [Indexed: 11/30/2022] Open
Abstract
Background Syncope is a transient loss of consciousness occasionally occurring in dogs with advanced myxomatous mitral valve disease (MMVD). Objective (1) To study ECG changes during syncopal episodes in dogs with advanced MMVD and (2) to compare the occurrence of arrhythmias and changes in heart rate variability (HRV) between dogs with advanced MMVD with and without a history of syncope. Animals Forty‐three privately owned dogs (<15 kg) with advanced MMVD: 21 with and 22 without a history of syncope. Methods Prospective study with dogs recruited for an evaluation including history, physical examination, echocardiography, and arrhythmia and HRV analysis performed on 24‐hour Holter recordings. Results A syncopal episode was observed during Holter monitoring in 4 dogs: 3 dogs had sinus rhythm and 1 dog had sinus arrest followed by escape rhythm. An arrhythmia variable representing sinus arrhythmia was significantly lower in dogs with a history of syncope than in those without (P = .008). Eight of 26 HRV variables were significantly different between dogs with and without a history of syncope. Conclusions and Clinical Importance Compared with dogs without a history of syncope, dogs with advanced MMVD and a history of syncope did not have a higher occurrence of arrhythmias, but had less sinus arrhythmia, and had changes in HRV variables representing decreased overall HRV, decreased parasympathetic, and increased sympathetic modulation of heart rate.
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Affiliation(s)
- C E Rasmussen
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Sanders R, Olivier NB. Novel cutaneous use of implantable loop recorders in two dogs with unexplained episodes of collapse. J Am Anim Hosp Assoc 2012; 48:269-72. [PMID: 22611211 DOI: 10.5326/jaaha-ms-5766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Determining the cause of episodes of collapse can be difficult. Even in patients with frequent collapsing episodes due to cardiac causes, diagnostic surface electrocardiogram and 24 hr ambulatory electrocardiographic (Holter) monitoring are sometimes inconclusive. Event monitors with multiple leads can be challenging to use in veterinary medicine over long periods of time due to lead dislodgment. Implantable leadless loop recorders (ILRs) are useful, but owners are sometimes unwilling to have an ILR implanted due to the associated risks and/or costs. In this case report, the authors describe the use of cutaneously placed ILRs in two dogs with unexplained episodes of collapse/exercise intolerance. Data recorded provided clinically useful information. Cutaneously placed ILRs can be used effectively in veterinary medicine to evaluate patients with unexplained episodes of collapse.
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Affiliation(s)
- Robert Sanders
- Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
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MacKie BA, Stepien RL, Kellihan HB. Retrospective analysis of an implantable loop recorder for evaluation of syncope, collapse, or intermittent weakness in 23 dogs (2004–2008). J Vet Cardiol 2010; 12:25-33. [DOI: 10.1016/j.jvc.2009.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 12/30/2009] [Indexed: 11/15/2022]
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Santilli RA, Ferasin L, Voghera SG, Perego M. Evaluation of the diagnostic value of an implantable loop recorder in dogs with unexplained syncope. J Am Vet Med Assoc 2010; 236:78-82. [DOI: 10.2460/javma.236.1.78] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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