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Avison A, Gelzer AR, Reef VB, Wulster Bills KB, de Solis CN, Kraus MS, Slack J, Stefanovski D, Deacon LJ, Underwood C. Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses. J Vet Intern Med 2024; 38:1751-1764. [PMID: 38514200 PMCID: PMC11099695 DOI: 10.1111/jvim.17027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. OBJECTIVE To describe temporary, medium-term (24 h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. ANIMALS Six healthy adult institutional teaching horses. METHODS Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24 h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6 h, and pacing thresholds were recorded every 6 h. Pacing failure was defined as a period of loss of capture longer than 20 s. RESULTS Pacing leads were placed with both guidance methods and maintained for 24 h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P < 0.05. CONCLUSIONS AND CLINICAL IMPORTANCE Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.
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Affiliation(s)
- Amanda Avison
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia B. Reef
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Kathryn B. Wulster Bills
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Cris Navas de Solis
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - JoAnn Slack
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Lindsay J. Deacon
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Claire Underwood
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
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2
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Heun F, Niebuhr T, Gutierrez Bautista A, Wiedmann F, Verhaar N, Kästner S, Feige K, Schmidt C. Treatment of a Paroxysmal Atrioventricular Block by Implantation of a Bipolar, Single-Chamber Cardiac Pacemaker in a Donkey. Animals (Basel) 2023; 13:2724. [PMID: 37684988 PMCID: PMC10486563 DOI: 10.3390/ani13172724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
CASE SUMMARY A two-year-old donkey presented with recurrent syncope. Electrocardiography revealed periods without any atrioventricular conduction and without any ventricular escape rhythm with a duration of up to one minute. Finally, atrioventricular conduction resumed spontaneously with a preceding ventricular escape beat. Laboratory tests and echocardiography identified no reversible cause. The diagnosis of a paroxysmal atrioventricular block (PAVB) was made. Therefore, a single-chamber cardiac pacemaker was implanted under general anesthesia. The device was programmed in the VVI mode to prevent further syncope. The therapy was considered successful as the donkey revealed no further syncope during the follow-up period of 17 months. CLINICAL RELEVANCE Clinically relevant bradycardia is rare in equids. This is the first report to our knowledge to describe a PAVB, a term commonly used in human medicine, in a donkey. Detailed information about the diagnosis and the successful therapy is included, with a special focus on the implantation and programming of the permanent pacemaker.
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Affiliation(s)
- Frederik Heun
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Tobias Niebuhr
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Alvaro Gutierrez Bautista
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Felix Wiedmann
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Nicole Verhaar
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Sabine Kästner
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Karsten Feige
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hannover, Germany
| | - Constanze Schmidt
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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3
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Conze TM, Falkenau A, Goehring LS, May A. Complete AV block in a neonatal foal suffering from nutritional myodegeneration. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. M. Conze
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
| | - A. Falkenau
- Institute of Veterinary Pathology Ludwig‐Maximilians University, Munich Munich Germany
| | - L. S. Goehring
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
| | - A. May
- Equine Hospital Ludwig‐Maximilians University Munich Munich Germany
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4
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d'Anselme O, Robel M, Schwarzwald C, Ringer SK. Anaesthesia management of transvenous implantation of a single‐chamber, rate‐adaptive pacemaker in a donkey with high‐grade second and third degree atrioventricular block. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Olivia d'Anselme
- Section of Anaesthesiology Department of Clinical Diagnostics and Services Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Matthias Robel
- Clinic for Equine Internal Medicine Equine Department Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Colin Schwarzwald
- Clinic for Equine Internal Medicine Equine Department Vetsuisse Faculty University of Zurich Zurich Switzerland
| | - Simone Katja Ringer
- Section of Anaesthesiology Department of Clinical Diagnostics and Services Vetsuisse Faculty University of Zurich Zurich Switzerland
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5
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De Lange L, Van Steenkiste G, Vernemmen I, Vera L, Cromheeke KMC, Walser U, Meert H, Decloedt A, van Loon G. Successful application of closed loop stimulation pacemakers with remote monitoring in 3 miniature donkeys with syncope. J Vet Intern Med 2021; 35:2920-2925. [PMID: 34741540 PMCID: PMC8692216 DOI: 10.1111/jvim.16305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Rate‐adaptive single chamber pacemakers with accelerometer, closed loop stimulation (CLS), and remote monitoring functionality (Eluna 8 SR‐T, Biotronik, SE & Co, Germany) were implanted in 3 miniature donkeys with third‐degree atrioventricular block and syncope. After recovery, different pacemaker programming modes were tested at rest, during stress without physical exercise and during physical exercise. Pacing rates were compared to actual atrial rates and showed that CLS functionality allowed physiological heart rate adaptation. A transmitter installed in the stable provided wireless connection of the pacemaker to the internet. Home monitoring was activated which performed daily wireless transmission of pacemaker functional measurements to an online server allowing diagnosis of pathological arrhythmias and pacemaker malfunction from a distance. Closed loop stimulation and remote monitoring functionality resulted in nearly physiological rate adaptation and allowed remote “from‐the‐stable” patient follow‐up.
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Affiliation(s)
- Lisa De Lange
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Ingrid Vernemmen
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Lisse Vera
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | | | - Ulla Walser
- Biotronik Belgium, Vilvoorde, Belgium.,Biotronik SE & Co. KG, Berlin, Germany
| | - Hans Meert
- Biotronik Belgium, Vilvoorde, Belgium.,Biotronik SE & Co. KG, Berlin, Germany
| | - Annelies Decloedt
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Gunther van Loon
- Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Merelbeke, Belgium
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6
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Carstensen H, Hesselkilde EZ, Fenner M, Loft-Andersen AV, Flethøj M, Kanters JK, Sattler SM, Tfelt-Hansen J, Pehrson S, Jespersen T, Buhl R. Time-dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses. J Vet Intern Med 2018; 32:1708-1717. [PMID: 30133839 PMCID: PMC6189357 DOI: 10.1111/jvim.15287] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/31/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022] Open
Abstract
Background Pharmacological treatment of atrial fibrillation (AF) in horses can be challenging because of low efficacy and adverse effects. Flecainide has been tested with variable efficacy. Objective To test whether the efficacy of flecainide is dependent on AF duration. Animals Nine Standardbred mares. Methods Factorial study design. All horses were instrumented with a pacemaker and assigned to a control or an AF group. On day 0, all horses were in sinus rhythm and received 2 mg/kg flecainide IV. Atrial fibrillation subsequently was induced in the AF group by pacemaker stimulation. On days 3, 9, 27, and 55, flecainide was administered to all horses, regardless of heart rhythm. Results All horses in AF cardioverted to sinus rhythm on days 3 and 9. On day 27, 5/6 horses cardioverted, whereas only 2/6 cardioverted on day 55. The time from the start of flecainide infusion to cardioversion (range, 3–185 min, log transformed) showed linear correlation with the cumulative duration of AF (r2 = .80, P < .0001). Flecainide induced abnormal QRS complexes in 4/6 AF horses and 1/3 controls. A positive correlation was found between heart rate before flecainide infusion and number of abnormal QRS complexes (0.14, P < .05). One horse suffered from cardiac arrest and died after flecainide infusion. Conclusions and Clinical Importance Flecainide is effective for cardioversion of short‐term induced AF, but the effect decreases with AF duration. Controlling heart rate may minimize adverse effects caused by flecainide, but the drug should be used with great caution.
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Affiliation(s)
- Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva Z Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Merle Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Ameli V Loft-Andersen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Mette Flethøj
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Stefan M Sattler
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, København, Denmark.,Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig-Maximilians University Munich (LMU), Munich, Germany
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, København, Denmark.,Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, København, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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7
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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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8
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Buhl R, Carstensen H, Hesselkilde EZ, Klein BZ, Hougaard KM, Ravn KB, Loft-Andersen AV, Fenner MF, Pipper C, Jespersen T. Effect of induced chronic atrial fibrillation on exercise performance in Standardbred trotters. J Vet Intern Med 2018; 32:1410-1419. [PMID: 29749082 PMCID: PMC6060327 DOI: 10.1111/jvim.15137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia affecting performance in horses. However, no previous studies have quantified the performance reduction in horses suffering from AF. Objectives To quantify the effect of AF on maximum velocity (Vmax), maximum heart rate (HRmax), heart rate recovery (T100), hematologic parameters and development of abnormal QRS complexes. Animals Nine Standardbred trotters. Methods Two‐arm controlled trial. Six horses had AF induced by means of a pacemaker and 3 served as sham‐operated controls. All horses were subjected to an exercise test to fatigue before (SET1) and after (SET2) 2 months of AF or sham. The Vmax and HRmax were assessed using a linear mixed normal model. Abnormal QRS complexes were counted manually on surface ECGs. Results Atrial fibrillation resulted in a 1.56 m/sec decrease in Vmax (P < .0001). In the AF group, HRmax ± SD increased from 226 ± 11 bpm at SET1 to 311 ± 27 bpm at SET 2. The AF group had higher HRmax at SET2 compared with controls (P < .0001), whereas no difference between the control and AF groups was observed at SET1 (P = .96). Several episodes of wide complex tachycardia were observed during exercise in 3 of the AF horses during SET2. Conclusions and Clinical Importance Atrial fibrillation resulted in a significant reduction in performance, an increase in HR and development of abnormal QRS complexes during exercise, which may be a risk factor for collapse or sudden cardiac death.
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Affiliation(s)
- Rikke Buhl
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Eva Zander Hesselkilde
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Bjørg Zinkernagel Klein
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Karen Margrethe Hougaard
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Kirsten Bomberg Ravn
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | | | - Merle Friederike Fenner
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Copenhagen, Denmark
| | - Christian Pipper
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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Luethy D, Slack J, Kraus MS, Gelzer AR, Habecker P, Johnson AL. Third-Degree Atrioventricular Block and Collapse Associated with Eosinophilic Myocarditis in a Horse. J Vet Intern Med 2017; 31:884-889. [PMID: 28295606 PMCID: PMC5435066 DOI: 10.1111/jvim.14682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/10/2017] [Accepted: 01/31/2017] [Indexed: 12/01/2022] Open
Abstract
Third‐degree atrioventricular block (AVB) and primary inflammatory myocarditis are uncommon findings in horses. The horse of this report presented for collapse at rest and was found to have multiple cardiac arrhythmias, most notably 3rd‐degree AVB. The horse was subsequently diagnosed with eosinophilic myocarditis on necropsy, a rare form of myocarditis not previously reported in horses. Despite extensive testing, an etiologic agent could not be identified, illustrating the difficulty in identifying a specific cause of myocarditis in horses.
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Affiliation(s)
- D Luethy
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - J Slack
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - M S Kraus
- Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - A R Gelzer
- Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Habecker
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
| | - A L Johnson
- Department of Clinical Studies-New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA
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