Topic:Atrial Function
Atrial function in horses pertains to the mechanical and electrical activities of the atria, the upper chambers of the heart, which are integral to the overall cardiac cycle. The atria are responsible for receiving blood from the body and lungs and facilitating its movement into the ventricles. Proper atrial function ensures efficient cardiac output and circulation. In equine cardiology, evaluating atrial function involves assessing parameters such as atrial size, contractility, and electrical conduction patterns. Changes or impairments in atrial function can be indicative of underlying cardiac conditions, such as atrial fibrillation or other arrhythmias. This page compiles peer-reviewed research studies and scholarly articles that explore the mechanisms, assessment methods, and clinical implications of atrial function in horses.
Endurance exercise induces distinct skeletal and cardiac mitochondrial adaptations in racehorses. Mitochondrial respiration sustains the high energy demands of endurance exercise, yet the extent to which atrial, ventricular, and skeletal muscle mitochondria adapt remains uncertain. At the same time, endurance athletes face an increased risk of atrial fibrillation (AF), but the role of cardiac metabolism in arrhythmia susceptibility is poorly understood. Here, we compared mitochondrial respiration in skeletal muscle and across all four cardiac chambers between trained and untrained racehorses ( = 34) to investigate adaptations associated with long-term endurance exercise. We further examine...
Orthodromic Atrioventricular Reentry Bradycardia and Tachycardia Caused by an Accessory Pathway in Horses. Accessory pathways (APs) are muscular bundles directly connecting the atria and ventricles, bypassing the atrioventricular (AV) node-His-Purkinje system. Anterograde conduction along the AP results in ventricular preexcitation. A retrograde conducting AP allows ventriculo-atrial (VA) conduction, creating a reentry circuit that mediates orthodromic atrioventricular reentry tachycardia (OAVRT). This condition is well described in humans and small animals, but has not been reported previously in horses. Objective: Describe clinical and electrocardiographic findings of horses with retrograde AP co...
Morphological variations of the interatrial septum and potential implications in equine cardiology. The interatrial septum morphology, shaped by the septum primum and secundum fusion, results in the formation of the fossa ovalis (FO) and its limbus. Incomplete fusion can lead to a patent foramen ovale (PFO), while complete fusion may produce septal ridges and pouches (SPs), with SPs in humans linked to ischemic stroke and atrial arrhythmias. In horses, atrial tachycardia and fibrillation often originate near the FO. This study examines adult equine interatrial septum morphology to enhance understanding the region and guide electrophysiological interventions for equine cardiac arrhythmias. Po...
Caudal vena cava isolation using ablation index-guided radiofrequency catheter ablation (CARTO™ 3) to treat sustained atrial tachycardia in horses. Myocardial sleeves of the caudal vena cava are the predilection site for atrial tachycardia (AT) in horses. Caudal vena cava isolation guided by the ablation index, a lesion quality marker incorporating power, duration and contact force, might improve outcome. Objective: Describe the feasibility and outcome of caudal vena cava isolation using ablation index-guided radiofrequency catheter ablation (RFCA) to treat AT in horses. Methods: Ten horses with sustained AT. Methods: Records from 10 horses with sustained AT treated by three-dimensional electro-anatomical mapping and ablation index-guided...
Rational quinidine dosage regimen for atrial fibrillation in Thoroughbred racehorses based on population pharmacokinetics. Quinidine (QND) sulfate is an effective treatment for atrial fibrillation (AF) in horses, and several dosage regimens have been proposed to address its wide variability in response and potential adverse effects. The purpose of this study was to analyze the variability in plasma quinidine concentrations using population pharmacokinetics to determine an effective and safe dosage regimen for Thoroughbred horses. Unassigned: Six healthy Thoroughbred horses were treated with 20 mg/kg quinidine sulfate dihydrate (16.58 mg/kg QND base) administered PO or 5 mg/kg quinidine hydrochloride monohydr...
Intracardiac ultrasound-guided transseptal puncture in horses: Outcome, follow-up, and perioperative anticoagulant treatment. Cardiac catheterizations in horses are mainly performed in the right heart, as access to the left heart traditionally requires an arterial approach. Transseptal puncture (TSP) has been adapted for horses but data on follow-up and closure of the iatrogenic atrial septal defect (iASD) are lacking. Objective: To perform TSP and assess postoperative complications and iASD closure over a minimum of 4 weeks. Methods: Eleven healthy adult horses. Methods: Transseptal puncture was performed under general anesthesia. Serum cardiac troponin I concentrations were measured before and after puncture. Wee...
Histological evaluation of cardiac remodelling in equine athletes. Approximately 1-2 per 100,000 young athletes die from sudden cardiac death (SCD) and extreme exercise may be associated with myocardial scar and arrhythmias. Racehorses have a high prevalence of atrial fibrillation (AF) and SCD but the presence of myocardial scar and inflammation has not been evaluated. Cardiac tissues from the left (LAA) and right (RAA) atrial appendages, left ventricular anterior (LVAPM) and posterior (LVPPM) papillary muscles, and right side of the interventricular septum (IVS-R) were harvested from racehorses with sudden cardiac death (SCD, n = 16) or other fatal injur...
Validation and clinical application of implantable loop recorders for diagnosis of atrial fibrillation in horses. Paroxysmal atrial fibrillation (pAF) occurs sporadically and can impair athletic performance. Gold standard for diagnosis is surface electrocardiography (ECG), however, this requires AF to be sustained. Implantable loop recorders (ILRs) are routinely used for AF detection in human medicine. While ILR placement has been studied in horses, its AF detection performance is unknown. Objective: (I) Validation of ILRs for AF detection in horses. (II) Determining pAF incidence using ILRs and estimate the positive predictive value (PPV). Methods: (I) Experimental study; (II) Longitudinal observational ...
Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test. Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. Objective: To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. Methods: Two-arm controlled experiment. Methods: Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25-44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including trachea...
Long-Term Training Increases Atrial Fibrillation Sustainability in Standardbred Racehorses. Atrial fibrillation (AF) is more prevalent in athletes, and currently, the mechanisms are not fully understood. Atrial fibrillation inducibility and stability was investigated in trained and untrained Standardbred racehorses. The horses underwent echocardiography for evaluation of atrial size. High-density mapping during AF was performed, and the presence of structural remodeling, as well as the expression of inflammatory and pro-inflammatory markers in the atria, was studied. Atrial fibrillation sustained significantly longer after tachypacing in the trained horses, whereas no difference in A...
Assessment of P Wave Indices in Healthy Standardbred Horses. P wave indices are used as non-invasive electrocardiographic markers of atrial remodelling in humans. Few studies have investigated their use in animals. The aim of this study was to measure P wave duration and P wave dispersion (Pd) in healthy standardbred horses and investigate variables that might influence these measurements. A 12-lead electrocardiogram was recorded at rest and P wave indices were calculated in 53 horses. A general linear model was used to investigate the main effects: age, bodyweight, sex, resting heart rate, presence of a murmur, exercise status and the number of years r...
Equine echocardiography: Can dobutamine infusion correct alterations due to sedation with alpha-2 agonists? For the echocardiographic examination horses should not be sedated unless absolutely necessary because this alters cardiac dimensions and indices of function. However, some horses do not tolerate the echocardiographic procedure and require sedation to conduct the examination safely and obtain good quality images. The objective of this study was to evaluate whether the concurrent infusion of dobutamine in horses sedated with romifidine counteracts the cardiovascular changes observed with sedation alone. Twelve healthy untrained Standardbred mares were used. Three echocardiographic examinations ...
Retrospective review of atrial fibrillation in Standardbred racehorses at a tertiary care facility in Atlantic Canada. Atrial fibrillation (AF) is the most clinically relevant cardiac arrhythmia identified in the Standardbred racehorse. However, there is limited literature regarding athletic ability in Standardbred racehorses following AF conversion. To investigate this issue, the objectives of this review were to: i) determine the success rate in using quinidine sulphate to treat AF in a population of hospitalized equine patients in Atlantic Canada between January 2008 and December 2019; and ii) measure return to athletic ability (using racetrack earnings and top-3 finishes) following cardioversion with quini...
Cardiovascular changes in horses with atrial fibrillation and high thyroid hormone concentration: a case-control study. Hyperthyroidism is a predisposing factor for atrial fibrillation (AF) in humans. The relationship between high thyroid hormone (TH) and AF in horses has not been evaluated. Objective: The aim of this study is to identify whether (1) high TH concentrations were present in horses with AF, (2) other cardiovascular effects were observed in horses with high TH and AF, and (3) TH status affected recurrence rate. Methods: Twenty-three horses presented with naturally occurring AF. Methods: Prospective case-control clinical study. Thyroid hormone concentration was measured in horses presenting with AF....
Detection of the origin of atrial tachycardia by 3D electro-anatomical mapping and treatment by radiofrequency catheter ablation in horses. 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. Objective: To describe the feasibility of 3D electro-anatomical mapping and radiofrequency catheter ablation to characterize and treat sustained AT in horses. Methods: Nine horses with sustained AT. Methods: Records from horses with sustained AT referred for radiofrequency ablation at Ghen...
Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects. Atrial fibrillation (AF) is the most common arrhythmia in horses causing poor performance. As in humans, the condition can be intermittent in nature, known as paroxysmal atrial fibrillation (pAF). This review covers the literature relating to pAF in horses and includes references to the human literature to compare pathophysiology, clinical presentation, diagnostic tools and treatment. The arrhythmia is diagnosed by auscultation and electrocardiography (ECG), and clinical signs can vary from sudden loss of racing performance to reduced fitness or no signs at all. If left untreated, pAF may prom...
Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence. 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. Objective: To determine factors affecting cardioversion success, cardioversion difficulty and recurrence in a predominant Warmblood study sample. Methods: 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 cumulativ...
Detecting paroxysmal atrial fibrillation from normal sinus rhythm in equine athletes using Symmetric Projection Attractor Reconstruction and machine learning. Atrial fibrillation (AF) is a common cardiac arrhythmia in both human and equine populations. It is associated with adverse outcomes in humans and decreased athletic performance in both populations. Paroxysmal atrial fibrillation (PAF) presents with intermittent, self-terminating AF episodes, and is difficult to diagnose once sinus rhythm resumes. Unassigned: We aimed to detect PAF subjects from normal sinus rhythm equine electrocardiograms (ECGs) using the Symmetric Projection Attractor Reconstruction (SPAR) method to encapsulate the waveform morphology and variability as the basis of a machi...
Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion. 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. Objective: Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Methods: Retrospective multicentre study. Methods: Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatmen...
Fundamentals of arrhythmogenic mechanisms and treatment strategies for equine atrial fibrillation. 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 ...
Heritability estimates of atrial fibrillation in Thoroughbred racehorses in Hong Kong and Australia. Atrial fibrillation (AF) is the most common performance-limiting arrhythmia of racehorses. A genetic contribution has been suggested in Standardbred racehorses but has not been investigated in Thoroughbreds. The objective of this study was to determine the heritability of AF in Thoroughbred racehorses. Methods: Horses racing between 2007 and 2019 in Hong Kong and Australia that had AF detected postrace via auscultation (n = 463 cases) were compared with five randomly selected racing contemporaries (n = 2,315 controls). The ASReml-R programme was used to fit an animal model to the AF data t...
Quantification of left atrial contractile function using two-dimensional speckle tracking echocardiography in horses after conversion of atrial fibrillation to sinus rhythm. In horses, persistent atrial dysfunction is a prognostic indicator of recurrence of atrial fibrillation (AF). The objective of this study was to quantify left atrial (LA) contractile function in Warmblood horses after successful cardioversion of AF to sinus rhythm, using standard two-dimensional echocardiography (2DE) and two-dimensional speckle tracking (2DST) analyses, and to provide proof-of-concept for use of 2DST to detect LA contractile dysfunction in horses. Methods: Nineteen Warmblood horses with AF and successful transvenous electrical cardioversion (TVEC) or medical cardioversion usi...
Transthoracic echocardiography and its limitations in the diagnosis of congenital supernumerary aortic valve in a Thoroughbred. Aortic valve malformation is a common congenital abnormality reported in human medicine. The malformation is characterised by an increased or decreased number of cusps. Anatomical variations of the aortic valve that have been documented in humans include unicuspid, bicuspid, quadricuspid and quinticuspid valves. Two reports described a quadricuspid aortic valve in horses associated with either a ventricular septal defect (VSD) or tetralogy of Fallot. In this case report we describe the clinical and echocardiographic findings of a horse with a quadricuspid aortic valve as single congenital abno...
Incidence, recurrence, and outcome of postrace atrial fibrillation in Thoroughbred horses. Atrial fibrillation (AF) impacts performance and horse and jockey safety. Understanding the outcomes of AF identified postrace will better inform regulatory policy. Objective: To investigate the outcomes after episodes of AF identified postrace and determine whether affected horses are at increased risk of additional episodes compared to the general racing population. Methods: Total of 4684 Thoroughbred racehorses. Methods: Race records for Thoroughbred horses racing in Hong Kong from 2007 to 2017 were reviewed. Horses that performed below expectation were examined by cardiac auscultation and ...
Inhibition of Small-Conductance Calcium-Activated Potassium Current (I K,Ca) Leads to Differential Atrial Electrophysiological Effects in a Horse Model of Persistent Atrial Fibrillation. Small-conductance Ca2+-activated K+ (KCa2) channels have been proposed as a possible atrial-selective target to pharmacologically terminate atrial fibrillation (AF) and to maintain sinus rhythm. However, it has been hypothesized that the importance of the KCa2 current-and thereby the efficacy of small-conductance Ca2+-activated K+ current (I K,Ca) inhibition-might be negatively related to AF duration and the extent of AF-induced remodeling. Unassigned: To address the hypothesis of the efficacy of I K,Ca inhibition being dependent on AF duration, the anti-arrhythmic properties of the I K,Ca inh...
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. 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. Methods: 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. Methods: Clinical records of h...
Atrial fibrillation in horses Part 2: Diagnosis, treatment and prognosis. 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 e...
Implantable loop recorders can detect paroxysmal atrial fibrillation in Standardbred racehorses with intermittent poor performance. Limited information is available on paroxysmal atrial fibrillation (PAF) in the horse. Indeed, undiagnosed PAF could result in poor performance. Due to the intermittent occurrence, PAF is difficult to diagnose. However, implanting a small ECG device (implantable loop recorder, ILR) subcutaneously, allows the continuous and automatic detection of PAF. Objective: The aim was to investigate the potential of ILRs as a tool for diagnosing PAF in horses with poor performance. Methods: Prospective field study. Methods: Twelve racing Standardbred trotters with intermittent reduced performance (mean ag...
ECG Restitution Analysis and Machine Learning to Detect Paroxysmal Atrial Fibrillation: Insight from the Equine Athlete as a Model for Human Athletes. Atrial fibrillation is the most frequent arrhythmia in both equine and human athletes. Currently, this condition is diagnosed via electrocardiogram (ECG) monitoring which lacks sensitivity in about half of cases when it presents in paroxysmal form. We investigated whether the arrhythmogenic substrate present between the episodes of paroxysmal atrial fibrillation (PAF) can be detected using restitution analysis of normal sinus-rhythm ECGs. In this work, ECG recordings were obtained during routine clinical work from control and horses with PAF. The extracted QT, TQ, and RR intervals were used fo...