Implantable loop recorders can detect paroxysmal atrial fibrillation in Standardbred racehorses with intermittent poor performance.
Abstract: 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 age: six years) were enrolled prospectively. The ILR was implanted subcutaneously at the fifth or sixth left intercostal space and data from the ILR was collected during the study period in which the horses were followed for a median duration of 7.5 month (range 6-28). Results: The ILR was able to detect PAF in four out of twelve racehorses. The ILR also detected sustained atrial fibrillation (AF) in one horse during the study. The ILRs rely on RR detection and R waves were correctly identified in 96%. One hundred episodes were categorised as AF by the ILRs and subsequently visual ECG inspection categorised 12 as sinus rhythm (SR), 28 as sinus arrhythmia (SA), 14 as other arrhythmias and 46 as AF episodes. The Root Mean Square of the Successive Differences (RMSSD) values were significantly increased for AF compared to SR and SA. Conclusions: Few horses included and duration of study period varied among the horses. Further it was not possible to assess the sensitivity of the device in the current study and the ILRs proved to have a high rate of false positive misclassifications. Conclusions: This study indicates that ILRs can be used for detection of PAF episodes and could be a useful ECG tool for horses presenting with poor performance. This methodology provides a platform to facilitate the long-term assessment of AF development and quantification of AF burden in horses. Further studies including both healthy and poor performing horses are needed in order to learn more about PAF prevalence in racehorses.
© 2020 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Publication Date: 2020-11-23 PubMed ID: 33113157PubMed Central: PMC8451893DOI: 10.1111/evj.13372Google Scholar: Lookup
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- Journal Article
- Athletic Performance
- Atrial Function
- Cardiac Arrhythmias
- Cardiovascular Health
- Clinical Study
- Diagnosis
- Diagnostic Technique
- Disease
- Disease Diagnosis
- Electrocardiography
- Equine Health
- Exercise Physiology
- Field Study
- Heart Rate
- Horse Racing
- Horses
- Performance Horses
- Standardbred Horses
- Veterinary Medicine
- Veterinary Procedure
- Veterinary Research
Summary
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This research article investigates the potential of implantable loop recorders (ILR) as a tool for diagnosing paroxysmal atrial fibrillation (PAF) in racing Standardbred horses experiencing poor performance.
Research Objective
- The focus of the study was to determine the effectiveness of ILRs in identifying episodes of PAF in racing Standardbred horses who demonstrated reduced performance or race results.
Methodology
- A total of twelve racing Standardbred trotters with intermittent reduced performance were examined. The horses’ mean age was six years.
- An ILR, a tiny ECG device, was implanted under the skin at the fifth or sixth intercostal space of the each horse.
- Throughout the field study, which had a median duration of 7.5 months, data from the ILR was continuously collected and assessed.
Results
- With the aid of the ILR, PAF was detected in four out of the twelve racehorses, and sustained atrial fibrillation (AF) in one horse during the examination period.
- ILRs, which function on RR detection, accurately identified R waves in 96% of cases.
- Of the 100 episodes recorded as AF by the ILRs, 12 were visually inspected and reclassified as sinus rhythm (SR), 28 as sinus arrhythmia (SA), 14 as other arrhythmias, and 46 were verified as AF episodes.
- The Root Mean Square of the Successive Differences (RMSSD) values for AF were found to be notably higher compared to SR and SA.
Conclusions
- The study faced limitations in terms of having a small cohort size and varying study durations for each horse.
- An additional challenge was the inability to measure the sensitivity of the ILR within the confines of the study, and a notable number of false-positive misclassifications.
- Despite these challenges, the study indicates that ILRs can effectively detect PAF episodes in horses and could serve as an effective ECG tool for racehorses experiencing poor performance.
- This methodology also presents a basis on which to carry out long-term evaluation of AF development and for quantifying the AF burden in horses.
- The researchers recommend further studies involving both healthy and poor-performing horses to better understand the prevalence of PAF in racehorses.
Cite This Article
APA
Buhl R, Nissen SD, Winther MLK, Poulsen SK, Hopster-Iversen C, Jespersen T, Sanders P, Carstensen H, Hesselkilde EM.
(2020).
Implantable loop recorders can detect paroxysmal atrial fibrillation in Standardbred racehorses with intermittent poor performance.
Equine Vet J, 53(5), 955-963.
https://doi.org/10.1111/evj.13372 Publication
Researcher Affiliations
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Centre for Heart Rhythm Disorders, Royal Adelaide Hospital and University of Adelaide, Adelaide, Australia.
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
MeSH Terms
- Animals
- Atrial Fibrillation / diagnosis
- Atrial Fibrillation / veterinary
- Electrocardiography, Ambulatory
- Horse Diseases / diagnosis
- Horses
- Prevalence
- Prospective Studies
- Prostheses and Implants
Grant Funding
- DFF-7017-00050 / Independent Research Fund Denmark
- Foreningen KUSTOS af 1881
Conflict of Interest Statement
No competing interests have been declared.
References
This article includes 25 references
- 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.
- Reef VB, Bonagura J, Buhl R, McGurrin MK, Schwarzwald CC, van Loon G. Recommendations for management of equine athletes with cardiovascular abnormalities.. J Vet Intern Med 2014;28:749–61.
- Broux B, De Clercq D, Decloedt A, Ven S, Vera L, van Steenkiste G. Heart rate variability parameters in horses distinguish atrial fibrillation from sinus rhythm before and after successful electrical cardioversion.. Equine Vet J 2017;49:723–8.
- Alexeenko V, Fraser JA, Bowen M, Huang CLH, Marr CM, Jeevaratnam K. The complexity of clinically‐normal sinus‐rhythm ECGs is decreased in equine athletes with a diagnosis of paroxysmal atrial fibrillation.. Sci Rep 2020;10:6822.
- Gallant L, Jacob S, Tadros E, Woodrow J, Hines M, Ewart S. Rapid screening for cardiac arrhythmias in competition draft horses.. Comparative Exercise Physiol 2019;15:291–8.
- Carstensen H, Hesselkilde EZ, Fenner M, Loft‐Andersen AV, Flethøj M, Kanters JK. Time‐dependent antiarrhythmic effects of flecainide on induced atrial fibrillation in horses.. J Vet Intern Med 2018;32:1708–17.
- Heijman J, Voigt N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression.. Circ Res 2014;114:1483–99.
- Hesselkilde EZ, Carstensen H, Flethoj 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.
- Amada A, Kurita H. Five cases of paroxysmal atrial fibrillation in the racehorse.. Experimental Rep Equine Health Laboratory 1975;1975:89–100.
- Holmes J, Henigan M, Williams R, Witherington D. Paroxysmal atrial fibrillation in racehorses.. Equine Vet J 1986;18:37–42.
- Hiraga A, Kubo K. Two cases of paroxysmal atrial fibrillation during exercise in horses.. Equine Vet Educ 1999;11:6–10.
- Buhl R, Hesselkilde EM, Carstensen H, Fenner MF, Jespersen T, Tfelt‐Hansen J. Detection of atrial fibrillation with implantable loop recorders in horses.. Equine Vet J 2021;53:397–403.
- Eitel C, Husser D, Hindricks G, Fruhauf M, Hilbert S, Arya A. Performance of an implantable automatic atrial fibrillation detection device: impact of software adjustments and relevance of manual episode analysis.. Europace: European pacing, arrhythmias, and cardiac electrophysiology: journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2011;13:480–5.
- Hindricks G, Pokushalov E, Urban L, Taborsky M, Kuck KH, Lebedev D. Performance of a New Leadless Implantable Cardiac Monitor in Detecting and Quantifying Atrial Fibrillation Results of the XPECT Trial.. Circ.‐Arrhythmia Electrophysiol 2010;3:141–U144.
- Burkowitz J, Merzenich C, Grassme K, Bruggenjurgen B. Insertable cardiac monitors in the diagnosis of syncope and the detection of atrial fibrillation: A systematic review and meta‐analysis.. Eur J Prev Cardiol 2016;23:1261–72.
- Frontera A, Carpenter A, Ahmed N, Fasiolo M, Nelson M, Diab I. Demographic and Clinical Characteristics to Predict Paroxysmal Atrial Fibrillation: Insights from an Implantable Loop Recorder Population.. Pace‐Pacing and Clinical Electrophysiol 2015;38:1217–22.
- Sanders P, Purerfellner H, Pokushalov E, Sarkar S, Di Bacco M, Maus B. Performance of a new atrial fibrillation detection algorithm in a miniaturized insertable cardiac monitor: Results from the Reveal LINQ Usability Study.. Heart Rhythm 2016;13:1425–30.
- Buhl R, Petersen EE, Lindholm M, Bak L, Nostell K. Cardiac Arrhythmias in Standardbreds During and After Racing—Possible Association Between Heart Size, Valvular Regurgitations, and Arrhythmias.. J Equine Vet Sci 2013;33:590–6.
- Malmo V, Nes BM, Amundsen BH, Tjonna AE, Stoylen A, Rossvoll O. Aerobic Interval Training Reduces the Burden of Atrial Fibrillation in the Short Term: A Randomized Trial.. Circulation 2016;133:466–73.
- Brignole M, Vardas P, Hoffman E, Huikuri H, Moya A, Ricci R. Indications for the use of diagnostic implantable and external ECG loop recorders.. Europace 2009;11:671–87.
- Woods DR, Allen S, Betts TR, Gardiner D, Montgomery H, Morgan JM. High altitude arrhythmias.. Cardiology 2008;111:239–46.
- Nattel S, Guasch E, Savelieva I, Cosio FG, Valverde I, Halperin JL. Early management of atrial fibrillation to prevent cardiovascular complications.. Eur Heart J 2014;35:1448–56.
- Camm AJ, Al‐Khatib SM, Calkins H, Halperin JL, Kirchhof P, Lip GY. A proposal for new clinical concepts in the management of atrial fibrillation.. Am Heart J 2012;164(292–302):e291.
- 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.
- . Clinical Manual Reveal Linq LNQ11. Online available at www.medtronics.com. 2013.
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