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Crooks AV, Hsue W, Tschabrunn CM, Gelzer AR. Feasibility of electroanatomic mapping and radiofrequency catheter ablation in Boxer dogs with symptomatic ventricular tachycardia. J Vet Intern Med 2022; 36:886-896. [PMID: 35307868 PMCID: PMC9151449 DOI: 10.1111/jvim.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Treatment for Boxers with ventricular tachycardia (VT) is limited. Electroanatomic mapping (EAM) facilitates identification of arrhythmogenic substrate for radiofrequency catheter ablation (RFCA). Objective Describe the use of EAM to guide RFCA in Boxers with VT. Animals Five client‐owned Boxers with symptomatic VT or persistent VT despite antiarrhythmic medications. Methods Case series evaluating clinical, EAM, and before and after RFCA Holter data. Results Sustained VT was inducible in 3 dogs, but required aggressive stimulation protocols. Low‐voltage areas consistent with electroanatomic scar were found in 2 dogs, located at the right ventricular (RV) outflow tract and cranial RV. Two dogs had a focal activation pattern of VT and 1 dog had a reentrant mechanism. After RFCA, all dogs no longer collapsed and had fewer runs of VT, 3 of which had 0 runs of VT. Number of ventricular premature beats increased in 3 dogs and decreased in 2 dogs, 1 of which had nearly complete resolution of all arrhythmias. Procedural complications included ventricular fibrillation (n = 2) with successful defibrillation, bruising or hemorrhage at the vascular access site (n = 4), retroperitoneal hemorrhage (n = 1), aortic and mitral regurgitation (n = 1), onset of frequent supraventricular tachycardia (n = 1), and persistent right pelvic limb lameness (n = 1). Conclusions and Clinical Importance Electroanatomic mapping and RFCA are feasible in Boxers with VT. Based on this small cohort, RFCA may help decrease runs of VT and improve clinical signs. The anatomic substrate and electrophysiologic mechanisms are variable and require further study.
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Affiliation(s)
- Alexandra V. Crooks
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Weihow Hsue
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Cory M. Tschabrunn
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced Medicine School of Veterinary Medicine, University of Pennsylvania Philadelphia Pennsylvania USA
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Holdt SL, Peckens NK, Rosenthal S, Cober R. Arrhythmogenic right ventricular cardiomyopathy in Bulldogs: Evaluation of clinical and histopathologic features, progression, and outcome in 71 dogs (2004-2016). J Vet Cardiol 2021; 40:170-183. [PMID: 34785174 DOI: 10.1016/j.jvc.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to characterize the clinical and histopathological features of arrhythmogenic right ventricular cardiomyopathy (ARVC) in English Bulldogs, American Bulldogs, and Bulldog-type mixed breed dogs and assess affected Bulldogs for a striatin gene mutation previously reported in Boxers with ARVC. ANIMALS Seventy-one Bulldogs fit the inclusion criteria. Genetic analysis was performed on five dogs. Cardiac post-mortem evaluations were performed on two dogs. METHODS Medical records from a single veterinary cardiology group (CVCA) were retrospectively evaluated. Tissue and blood samples were submitted for histopathological analysis and genetic testing in select patients. RESULTS Presenting complaints included syncope (38%), arrhythmia (81.7%), or murmur (34.2%) documented on examination. On presentation, congestive heart failure (CHF) was diagnosed in 22 (31%) dogs, and 58 (81.7%) had ventricular arrhythmias. On bivariable analyses, the two-dimensional (2D) left atrial-to-aortic root ratio (LA:Ao) was the only prognostic variable significantly associated with survival time. Dogs with 2D LA:Ao below the mean (1.41) had longer median survival to all-cause mortality (12 months; 95% confidence interval [CI] 6.0-15.0 months) than those with 2D LA:Ao above the mean (four months; 95% CI 2.0-6.0 months; p=0.0384). Most dogs (54%) died from cardiac disease, with 42.1% experiencing sudden death. The median time from diagnosis to cardiac death was four months. CONCLUSIONS Arrhythmogenic right ventricular cardiomyopathy affects Bulldogs with both arrhythmogenic and dilated-type phenotypes. Despite variable arrhythmia severity and predominantly right-sided involvement in many dogs, an increase in left atrial size was the only significant predictor of mortality in this sample of dogs.
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Affiliation(s)
- S L Holdt
- CVCA Cardiac Care for Pets (Vienna), 140 Park Street SE, Vienna, VA 22180, USA.
| | - N K Peckens
- CVCA Cardiac Care for Pets (Vienna), 140 Park Street SE, Vienna, VA 22180, USA
| | - S Rosenthal
- CVCA Cardiac Care for Pets (Towson), 1209 Cromwell Bridge Rd, Towson, MD 21286, USA
| | - R Cober
- CVCA Cardiac Care for Pets (Annapolis), 808 Bestgate Road, Annapolis, MD 21401, USA
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Cunningham SM, Dos Santos L. Arrhythmogenic right ventricular cardiomyopathy in dogs. J Vet Cardiol 2021; 40:156-169. [PMID: 34503916 DOI: 10.1016/j.jvc.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/29/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited myocardial disease seen in dogs, cats, and humans. A common entity in Boxers and the related English bulldog, the disease is characterized by fatty or fibrofatty replacement of the myocardium, ventricular arrhythmias, and the potential for syncope or sudden death. In some individuals, concomitant left ventricular involvement results in systolic dysfunction and a progression to congestive heart failure. The clinical and pathological characteristics of ARVC share many similarities in dogs and humans, and Boxers serve as an important spontaneous model of the disease. Although multiple mechanisms have been implicated in the pathogenesis of ARVC, the disease is ultimately considered to be a disorder of the desmosome. Multiple causal genetic mutations have been identified in people, and over 50% of affected humans have an identifiable mutation in desmosomal proteins. To date, only a single genetic mutation has been associated with ARVC in Boxer dogs. Other as-yet-undiscovered genetic mutations and epigenetic modifiers of the disease are likely. Treatment of ARVC in dogs is focused on controlling ventricular arrhythmias and associated clinical signs. This article will review the pathophysiology, clinical diagnosis, treatment, and prognosis of ARVC in the dog.
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Affiliation(s)
- S M Cunningham
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, 01536, MA, USA.
| | - L Dos Santos
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Road, North Grafton, 01536, MA, USA
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Shen L, Estrada AH, Meurs KM, Sleeper M, Vulpe C, Martyniuk CJ, Pacak CA. A review of the underlying genetics and emerging therapies for canine cardiomyopathies. J Vet Cardiol 2021; 40:2-14. [PMID: 34147413 DOI: 10.1016/j.jvc.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Cardiomyopathies such as dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy are common in large breed dogs and carry an overall poor prognosis. Research shows that these diseases have strong breed predilections, and selective breeding has historically been recommended to reduce the disease prevalence in affected breeds. Treatment of these diseases is typically palliative and aimed at slowing disease progression and managing clinical signs of heart failure as they develop. The discovery of specific genetic mutations underlying cardiomyopathies, such as the striatin mutation in Boxer arrhythmogenic right ventricular cardiomyopathy and the pyruvate dehydrogenase kinase 4 and titin mutations in Doberman Pinschers, has strengthened our ability to screen and selectively breed individuals in an attempt to produce unaffected offspring. The discovery of these disease-linked mutations has also opened avenues for the development of gene therapies, including gene transfer and genome-editing approaches. This review article discusses the known genetics of cardiomyopathies in dogs, reviews existing gene therapy strategies and the status of their development in canines, and discusses ongoing challenges in the clinical translation of these technologies for treating heart disease. While challenges remain in using these emerging technologies, the exponential growth of the gene therapy field holds great promise for future clinical applications.
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Affiliation(s)
- L Shen
- Program for Applied Research and Development in Genomic Medicine, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - A H Estrada
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, PO Box 100136, Gainesville, FL, 32610, USA
| | - K M Meurs
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607, USA
| | - M Sleeper
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, PO Box 100136, Gainesville, FL, 32610, USA
| | - C Vulpe
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Dr, Gainesville, FL, 32603, USA
| | - C J Martyniuk
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, 1333 Center Dr, Gainesville, FL, 32603, USA
| | - C A Pacak
- Department of Neurology, College of Medicine, University of Minnesota, 516 Delaware Street SE, Minneapolis, MN, 55455, USA
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Domingues M, Brookes VJ, Oliveira P, Mavropoulou A, Willis R. Heart rhythm during episodes of collapse in boxers with frequent or complex ventricular ectopy. J Small Anim Pract 2020; 61:127-136. [PMID: 32017114 DOI: 10.1111/jsap.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe heart rhythm during collapse events in boxer dogs using ambulatory electrocardiogram and determine the predictive value of frequent or complex ventricular ectopy for collapse associated with ventricular tachycardia. MATERIALS AND METHODS A total of 659 ambulatory electrocardiogram recordings from 429 boxer dogs were identified from a database in the UK. Summary statistics described the frequency and complexity of ventricular ectopy during all recordings, recordings in which collapse occurred and associated boxer demographics. Positive predictive values were calculated to investigate whether frequent ventricular ectopy was useful to predict heart rhythm during episodes of collapse. RESULTS Of the 659 ambulatory electrocardiogram recordings, 250 recordings showed <50 single ventricular beats (Group 1), and frequent (≥50) or complex ventricular ectopy were observed in 409 recordings (Group 2). A total of 90 collapse events were observed in 72 ambulatory electrocardiograms from 68 dogs, comprising 30 dogs in Group 1 and 38 dogs in Group 2. In both groups, sinus rhythm was the most frequent collapse rhythm, followed by neurally mediated collapse and then ventricular tachycardia. The proportion of dogs that displayed ventricular tachycardia-associated episodic collapse given that they had frequent (≥50) or complex ventricular ectopy in the study population was 0.11 [95% confidence interval = 0.01 to 0.21]. CLINICAL SIGNIFICANCE These results challenge the preconception that UK boxer dogs with collapse will have ventricular tachycardia and, consequently, the authors recommend definitive diagnosis of the cause of episodic collapse to guide selection of therapeutic drugs.
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Affiliation(s)
- M Domingues
- Dick White Referrals, Cambridge, CB8 0UH, UK
| | - V J Brookes
- School of Animal and Veterinary Sciences, Faculty of Science, Charles Sturt University, Wagga, Wagga, 2650, Australia
| | - P Oliveira
- Davies Veterinary Speclialists, Manor Farm Business Park, Hitchin, UK
| | - A Mavropoulou
- Davies Veterinary Speclialists, Manor Farm Business Park, Hitchin, UK
| | - R Willis
- Dick White Referrals, Cambridge, CB8 0UH, UK
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Cunningham SM, Sweeney JT, MacGregor J, Barton BA, Rush JE. Clinical Features of English Bulldogs with Presumed Arrhythmogenic Right Ventricular Cardiomyopathy: 31 Cases (2001–2013). J Am Anim Hosp Assoc 2018; 54:95-102. [DOI: 10.5326/jaaha-ms-6550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden death in people and boxer dogs that has recently been described in English bulldogs. The objective of this retrospective study was to describe the clinical characteristics of English bulldogs with presumed ARVC. The medical records were searched for English bulldogs examined between 2001 and 2013 with a clinical diagnosis of ARVC. The average age of the 31 dogs identified was 9.2 ± 1.6 yr (range 7–13 yr). Males were overrepresented by a factor of 2.9 to 1. At initial presentation, 5 dogs had subclinical arrhythmia, 10 dogs had clinical signs attributable to arrhythmia, and 16 dogs had congestive heart failure. Eighteen dogs (58%) had ventricular tachycardia and five (16%) also had supraventricular arrhythmias. Four dogs experienced sudden death, 2 dogs died from congestive heart failure, 11 dogs were euthanized for cardiac causes, and 2 dogs died or were euthanized for noncardiac causes. Kaplan-Meier analysis showed a median survival time of 8.3 mo. This is the first study to describe the clinical characteristics of a population of English bulldogs with presumed ARVC. Further studies are needed to better characterize the clinical features of the disease in this breed.
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Affiliation(s)
- Suzanne M. Cunningham
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Joseph T. Sweeney
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John MacGregor
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Bruce A. Barton
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John E. Rush
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
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Dutton E, Dukes-McEwan J, Cripps P. Serum cardiac troponin I in canine syncope and seizures. J Vet Cardiol 2017; 19:1-13. [DOI: 10.1016/j.jvc.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
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Comprehensive analysis of desmosomal gene mutations in Han Chinese patients with arrhythmogenic right ventricular cardiomyopathy. Eur J Med Genet 2015; 58:258-65. [PMID: 25765472 DOI: 10.1016/j.ejmg.2015.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
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Meurs KM, Stern JA, Reina-Doreste Y, Spier AW, Koplitz SL, Baumwart RD. Natural history of arrhythmogenic right ventricular cardiomyopathy in the boxer dog: a prospective study. J Vet Intern Med 2014; 28:1214-1220. [PMID: 24962663 PMCID: PMC4857953 DOI: 10.1111/jvim.12385] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 03/24/2014] [Accepted: 04/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background Boxer arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disease that may result in sudden death or heart failure. Hypothesis/objectives To prospectively study the natural history of Boxer ARVC. Animals 72 dogs (49 ARVC, 23 controls). Methods Boxers >1 year of age were recruited for annual reevaluation. Controls were defined as being ≥6 years of age and having <50 ventricular premature complex (VPCs)/24 h. ARVC was defined as ≥300 VPCs/24 h in the absence of other disease. Dogs were genotyped for the striatin deletion when possible. Descriptive statistics were determined for age; VPC number; annual change in VPC number; and left ventricular (LV) echocardiographic dimensions. Survival time was calculated. Results Controls: median age of 7 years (range, 6–10); number of VPCs 12 (range, 4–32). Median time in study of 6 years (range, 2–9). Seventeen of 23 were genotyped (5 positive, 12 negative). ARVC: median age of diagnosis of 6 (range, 1–11). Median time in study 5 years (range, 3–8). A total of 33% were syncopal and 43/49 were genotyped (36 positive, 7 negative). Yearly change in VPCs was 46 (range, −7,699 to 33,524). Annual percentage change in LV dimensions was 0, and change in fractional shortening (FS%) was 2%. Two dogs had FS% <20%. Although ARVC dogs died suddenly, there was no difference in survival time between groups. ARVC median age of survival was 11 years, and for controls was 10 years. Conclusions/Clinical Importance Arrhythmogenic right ventricular cardiomyopathy is a disease of middle age and frequently is associated with the striatin deletion. Syncope occurs in approximately 1/3 of affected dogs; systolic dysfunction is uncommon. The prognosis in many affected dogs is good.
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Affiliation(s)
- K M Meurs
- The Ohio State University College of Veterinary Medicine, Columbus, OH.,North Carolina State University College of Veterinary Medicine, Raleigh, NC
| | - J A Stern
- The Ohio State University College of Veterinary Medicine, Columbus, OH.,North Carolina State University College of Veterinary Medicine, Raleigh, NC
| | - Y Reina-Doreste
- North Carolina State University College of Veterinary Medicine, Raleigh, NC
| | - A W Spier
- The Ohio State University College of Veterinary Medicine, Columbus, OH
| | - S L Koplitz
- The Ohio State University College of Veterinary Medicine, Columbus, OH
| | - R D Baumwart
- The Ohio State University College of Veterinary Medicine, Columbus, OH
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