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Home / Equine Research Bank / Equine Vet J / Atrial fibrillatory rate as predictor of recurrence of atria...
Equine veterinary journal2022; 54(6); 1013-1022; doi: 10.1111/evj.13551

Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion.

Abstract: 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 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). Conclusions: 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.
© 2021 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2022-01-13 PubMed ID: 34957586PubMed Central: PMC9787611DOI: 10.1111/evj.13551Google Scholar: Lookup
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  • Journal Article
  • Multicenter Study

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research investigates the use of Atrial Fibrillatory Rate (AFR) to predict the possibility of Atrial Fibrillation (AF) recurring in horses that have undergone either medical treatment or transvenous electrical cardioversion therapy. It concludes that high AFR is linked to the failure of the medical treatment using quinidine and the recurrence of AF post-cardioversion.

Research Objective and Methodology

  • The goal of the study was to evaluate whether the Atrial Fibrillatory Rate (AFR), which can be collected non-invasively through electrocardiograms (ECGs), could indicate the likelihood of successfully treating Atrial Fibrillation (AF) and predict its recurrence.
  • The research conducted was a retrospective multicentre study, which included horses with persistent AF that underwent cardioversion either through medical treatment (using the drug quinidine) or transvenous electrical cardioversion (TVEC).
  • The researchers analyzed bipolar surface ECG recordings by the process of spatiotemporal cancellation of QRST complexes and calculated the AFR from the remaining atrial signal. Statistical methods including Kaplan-Meier survival curve and Cox regression analyses were used to assess the relationship between AFR and the risk of AF recurrence.

Research Outcome

  • The study included 195 horses, where 74 received quinidine treatment and 121 were treated with TVEC. Ten horses failed to cardiovert to Sinus Rhythm (SR) after quinidine treatment and they had a higher AFR compared to those that successfully converted to SR.
  • Within the first six months post-cardioversion, 12% of the horses treated with quinidine and 34% of those treated with TVEC saw recurrence of AF. For those successfully treated with TVEC, an AFR above 380 fibrillations per minute was significantly associated with AF recurrence.

Research Limitations

  • The groups under consideration for treatment weren’t randomly allocated, which makes it inappropriate to conduct a comparison between the two treatments.
  • The medical records and follow-up strategy differed between the centres involved in the study.

Conclusion

  • The study concludes that a high AFR is associated with the unsuccessful treatment of AF with quinidine and the recurrence of AF after successful TVEC treatment.
  • As AFR can be obtained non-invasively from surface ECG, it proves to be a clinically useful marker in predicting the probability of responding to quinidine treatment as well as the possibility of maintaining SR after electrical cardioversion.

Cite This Article

APA
Buhl R, Hesselkilde EM, Carstensen H, Hopster-Iversen C, van Loon G, Decloedt A, Van Steenkiste G, Marr CM, Reef VB, Schwarzwald CC, Mitchell KJ, Nostell K, Nogradi N, Nielsen SS, Carlson J, Platonov PG. (2022). Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion. Equine Vet J, 54(6), 1013-1022. https://doi.org/10.1111/evj.13551

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 54
Issue: 6
Pages: 1013-1022

Researcher Affiliations

Buhl, Rikke
  • Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Hesselkilde, Eva M
  • Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Carstensen, Helena
  • Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Hopster-Iversen, Charlotte
  • Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
van Loon, Gunther
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium.
Decloedt, Annelies
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium.
Van Steenkiste, Glenn
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Ghent University, Merelbeke, Belgium.
Marr, Celia M
  • Rossdales Equine Hospital, Newmarket, UK.
Reef, Virginia B
  • Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA.
Schwarzwald, Colin C
  • Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
Mitchell, Katharyn J
  • Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.
Nostell, Katarina
  • Department of Clinical Sciences, Faculty of Veteirnary Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Nogradi, Nora
  • Dubai Equine Hospital, Dubai, UAE.
Nielsen, Søren S
  • Department of Veterinary Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Carlson, Jonas
  • Department of Cardiology, Lund University, Lund, Sweden.
Platonov, Pyotr G
  • Department of Cardiology, Lund University, Lund, Sweden.

MeSH Terms

  • Animals
  • Atrial Fibrillation / therapy
  • Atrial Fibrillation / veterinary
  • Electric Countershock / veterinary
  • Electrocardiography / veterinary
  • Heart Atria
  • Horse Diseases / therapy
  • Horses
  • Quinidine

Grant Funding

  • 1S56217N / Research Foundation Flanders
  • 2200674 / The Swedish Heart-Lung Foundation
  • DFF-7017-00050 / Det Frie Forskningsråd
  • BOF.BAS.2018.0022.01 / Special Research Fund Ghent University
  • DFF-7017-00050 / Independent Research Fund Denmark

Conflict of Interest Statement

No competing interests have been declared.

References

This article includes 41 references
  1. Leroux AA, Detilleux J, Sandersen CF, Borde L, Houben R, Al Haidar A. Prevalence and risk factors for cardiac diseases in a hospital‐based population of 3,434 horses (1994–2011). J Vet Intern Med 2013;27:1563–70.
    pubmed: 24112454
  2. Ohmura H, Hiraga A, Takahashi T, Kai M, Jones JH. Risk factors for atrial fibrillation during racing in slow‐finishing horses. J Am Vet Med Assoc 2003;223:84–8.
    pubmed: 12839069
  3. Slack J, Boston RC, Soma LR, Reef VB. Occurrence of cardiac arrhythmias in Standardbred racehorses. Equine Vet J 2015;47:398–404.
    pubmed: 24819401
  4. Physick‐Sheard P, Kraus M, Basrur P. Breed predisposition and heritability of atrial fibrillation in the Standardbred horse: a retrospective case‐control study. J Vet Cardiol 2014;16:173–84.
    pubmed: 25087649
  5. Reef VB, Bonagura J, Buhl R, McGurrin M, Schwarzwald CC, van Loon G. Recommendations for management of equine athletes with cardiovascular abnormalities. J Vet Intern Med 2014;28:749–61.
    pmc: PMC4895474pubmed: 24628586
  6. Buhl R, Carstensen H, Hesselkilde EZ, Klein BZ, Hougaard KM, Ravn KB. Effect of induced chronic atrial fibrillation on exercise performance in Standardbred trotters. J Vet Intern Med 2018;32:1410–9.
    pmc: PMC6060327pubmed: 29749082
  7. Decloedt A, Van Steenkiste G, Vera L, Buhl R, van Loon G. Atrial fibrillation in horses part 2: diagnosis, treatment and prognosis. Vet J 2021;268:105594.
    pubmed: 33468306
  8. van Loon G, Blissitt KJ, Keen JA, Young LE. Use of intravenous flecainide in horses with naturally‐occurring atrial fibrillation. Equine Vet J 2004;36:609–14.
    pubmed: 15581326
  9. De Clercq D, van Loon G, Baert K, Tavernier R, Croubels S, De Backer P. Intravenous amiodarone treatment in horses with chronic atrial fibrillation. Vet J 2006;172:129–34.
    pubmed: 15908245
  10. Haugaard MM, Hesselkilde EZ, Pehrson S, Carstensen H, Flethøj M, Præstegaard KF. Pharmacologic inhibition of small‐conductance calcium‐activated potassium (SK) channels by NS8593 reveals atrial antiarrhythmic potential in horses. Heart Rhythm 2015;12:825–35.
    pubmed: 25542425
  11. Takahashi Y, Ishikawa Y, Ohmura H. Treatment of recent‐onset atrial fibrillation with quinidine and flecainide in Thoroughbred racehorses: 107 cases (1987–2014). J Am Vet Med Assoc 2018;252:1409–14.
    pubmed: 29772981
  12. Fenner MF, Carstensen H, Dalgas Nissen S. Effect of selective IK, ACh inhibition by XAF‐1407 in an equine model of tachypacing‐induced persistent atrial fibrillation. Br J Pharmacol 2020;177:3778–94.
    pmc: PMC7393200pubmed: 32436234
  13. Reef VB, Levitan CW, Spencer PA. Factors affecting prognosis and conversion in equine atrial fibrillation. J Vet Intern Med 1988;2:1–6.
    pubmed: 3221350
  14. McGurrin MK, Physick‐Sheard PW, Kenney DG. Transvenous electrical cardioversion of equine atrial fibrillation: patient factors and clinical results in 72 treatment episodes. J Vet Intern Med 2008;22:609–15.
    pubmed: 18466256
  15. Decloedt A, Schwarzwald CC, De Clercq D, Van Der Vekens N, Pardon B, Reef VB. Risk factors for recurrence of atrial fibrillation in horses after cardioversion to sinus rhythm. J Vet Intern Med 2015;29:946–53.
    pmc: PMC4895430pubmed: 25917409
  16. Vernemmen I, De Clercq D, Decloedt A, Vera L, Van Steenkiste G, van Loon G. Atrial premature depolarisations five days post electrical cardioversion are related to atrial fibrillation recurrence risk in horses. Equine Vet J 2020;52:374–8.
    pubmed: 31583742
  17. Nattel S, Harada M. Atrial remodeling and atrial fibrillation: recent advances and translational perspectives. J Am Coll Cardiol 2014;63:2335–45.
    pubmed: 24613319
  18. Everett TH, Li H, Mangrum JM, McRury ID, Mitchell MA, Redick JA. Electrical, morphological, and ultrastructural remodeling and reverse remodeling in a canine model of chronic atrial fibrillation. Circulation 2000;102:1454–60.
    pubmed: 10993867
  19. Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation 1995;92:1954–68.
    pubmed: 7671380
  20. De Clercq D, Decloedt A, Sys SU, Verheyen T, Van Der Vekens N, van Loon G. Atrial fibrillation cycle length and atrial size in horses with and without recurrence of atrial fibrillation after electrical cardioversion. J Vet Intern Med 2014;28:624–9.
    pmc: PMC4858013pubmed: 24611990
  21. Decloedt A, de Clercq D, van der Vekens N, Verheyen T, Ven S, van Loon G. Influence of detomidine on atrial fibrillation cycle length measured by intracardiac electrogram recording and by colour tissue Doppler imaging in horses. Equine Vet J 2016;48:21–6.
    pubmed: 25266765
  22. Hesselkilde EZ, Carstensen H, Haugaard MM, Carlson J, Pehrson S, Jespersen T. Effect of flecainide on atrial fibrillatory rate in a large animal model with induced atrial fibrillation. BMC Cardiovasc Disord 2017;17:289.
    pmc: PMC5723027pubmed: 29221440
  23. Hesselkilde EZ, Carstensen H, Flethøj M, Fenner M, Kruse DD, Sattler SM. Longitudinal study of electrical, functional and structural remodelling in an equine model of atrial fibrillation. BMC Cardiovasc Disord 2019;19.
    pmc: PMC6805623pubmed: 31638896
  24. Carstensen H, Hesselkilde EZ, Haugaard MM, Flethøj M, Carlson J, Pehrson S. Effects of dofetilide and ranolazine on atrial fibrillatory rate in a horse model of acutely induced atrial fibrillation. J Cardiovasc Electrophysiol 2019;30:596–606.
    pmc: PMC6849868pubmed: 30661267
  25. Van Steenkiste G, Carlson J, Decloedt A, Vera L, Buhl R, Platonov PG. 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;34:73–9.
    pubmed: 33611234
  26. Choudhary MB, Holmqvist F, Carlson J, Nilsson H‐J, Roijer A, Platonov PG. Low atrial fibrillatory rate is associated with spontaneous conversion of recent‐onset atrial fibrillation. Europace 2013;15:1445–52.
    pubmed: 23515337
  27. De Clercq D, van Loon G, Tavernier R, Duchateau L, Deprez P. Atrial and ventricular electrical and contractile remodeling and reverse remodeling owing to short‐term pacing‐induced atrial fibrillation in horses. J Vet Intern Med 2008;22:1353–9.
    pubmed: 19000247
  28. Bollmann A, Binias K‐H, Toepffer I, Molling J, Geller C, Klein HU. Importance of left atrial diameter and atrial fibrillatory frequency for conversion of persistent atrial fibrillation with oral flecainide. Am J Cardiol 2002;90:1011–4.
    pubmed: 12398975
  29. Bollmann A, Kanuru NK, McTeague KK, Walter PF, DeLurgio DB, Langberg JJ. Frequency analysis of human atrial fibrillation using the surface electrocardiogram and its response to ibutilide. Am J Cardiol 1998;81:1439–45.
    pubmed: 9645894
  30. Haissaguerre M, Lim K‐T, Jacquemet V. Atrial fibrillatory cycle length: computer simulation and potential clinical importance. Europace 2007;9:vi64–70.
    pubmed: 17959695
  31. Aoyama Y, Niwano S, Niwano H, Satoh A, Kishihara J, Ishikawa S. Repetitive evaluation of fibrillation cycle length predicts the efficacy of bepridil for interruption of long‐lasting persistent atrial fibrillation. Int Heart J 2011;52:353–8.
    pubmed: 22188708
  32. Husser D, Cannom DS, Bhandari AK, Stridh M, Sörnmo L, Olsson SB. Electrocardiographic characteristics of fibrillatory waves in new‐onset atrial fibrillation. Europace 2007;9:638–42.
    pubmed: 17470676
  33. Stridh M, Sornmo L. Spatiotemporal QRST cancellation techniques for analysis of atrial fibrillation. IEEE Trans Biomed Eng 2001;48:105–11.
    pubmed: 11235581
  34. Stridh M, Sornmo L, Meurling CJ, Olsson SB. Sequential characterization of atrial tachyarrhythmias based on ECG time‐frequency analysis. IEEE Trans Biomed Eng 2004;51:100–14.
    pubmed: 14723499
  35. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 2002;54:230–46.
    pubmed: 12062329
  36. Matsuo S, Lellouche N, Wright M, Bevilacqua M, Knecht S, Nault I. Clinical predictors of termination and clinical outcome of catheter ablation for persistent atrial fibrillation. J Am Coll Cardiol 2009;54:788–95.
    pubmed: 19695455
  37. Bollmann A, Husser D, Steinert R, Stridh M, Soernmo L, Olsson SB. Echocardiographic and electrocardiographic predictors for atrial fibrillation recurrence following cardioversion. J Cardiovasc Electrophysiol 2003;14:S162–5.
    pubmed: 14760919
  38. Holmqvist F, Stridh M, Waktare JEP. Atrial fibrillatory rate and sinus rhythm maintenance in patients undergoing cardioversion of persistent atrial fibrillation. Eur Heart J 2006;27:2201–7.
    pubmed: 16956916
  39. Morris DD, Fregin GF. Atrial fibrillation in horses: factors associated with response to quinidine sulfate in 77 clinical cases. Cornell Vet 1982;72:339–49.
    pubmed: 6754252
  40. Nattel S, Burstein B, Dobrev D. Atrial remodeling and atrial fibrillation: mechanisms and implications. Circ Arrhythm Electrophysiol 2008;1:62–73.
    pubmed: 19808395
  41. Covinsky JO, Russo J, Kelly KL, Cashman J, Amick EN, Mason WD. Relative bioavailability of quinidine gluconate and quinidine sulfate in healthy volunteers. J Clin Pharmacol 1979;19:261–9.
    pubmed: 469022
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