FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Equine Vet J / Successful caudal vena cava and pulmonary vein isolation in ...
Equine veterinary journal2023; 56(5); 1068-1076; doi: 10.1111/evj.14037

Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system.

Abstract: Recently, treatment of equine atrial tachycardia by three-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) has been described. Myocardial sleeves in the caudal vena cava and pulmonary veins are a potential trigger for initiation and perpetuation of atrial tachycardia and atrial fibrillation in the horse. Isolation of these myocardial sleeves by RFCA may be an effective treatment for these arrhythmias. Objective: To describe the feasibility of 3D EAM and RFCA to isolate caudal vena cava and pulmonary veins in adult horses using 3D mapping and a contact force (CF)-guided ablation system. Methods: In vivo experiments. Methods: 3D EAM and RFCA was performed in five horses without cardiovascular disease under general anaesthesia, using the CF-guided system CARTO®3. Point-by-point RFCA aimed for isolation of caudal vena cava and pulmonary veins. Radiofrequency energy was delivered in power-controlled mode with a target power of 45 W, CF between 10 and 15 g and 30 mL/min irrigation rate, until an ablation-index of 450-500 was reached. Results: In the right atrium, myocardial sleeves of the caudal vena cava were isolated (n = 5). In the left atrium, isolation of ostium II (n = 3), ostium III (n = 1) and ostium I, II and III en bloc (n = 1) was performed. Successful isolation was confirmed by entrance and exit block. Conclusions: Horses were euthanised at the end of the procedure, so long term effects such as potential reconnection of isolated veins could not be studied. Conclusions: This is the first description of 3D EAM and RFCA with CARTO®3 in horses, thereby showing the technical feasibility and successful caudal vena cava and pulmonary vein isolation. CF measurement allowed monitoring of catheter-tissue contact, resulting in efficient acute lesion creation as confirmed by entrance and exit block. This is a promising treatment for cardiac arrhythmias in horses.
© 2023 EVJ Ltd.
Get Full Text
Publication Date: 2023-12-27 PubMed ID: 38151793DOI: 10.1111/evj.14037Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article

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 describes a successful trial of a method called 3D electro-anatomical mapping and radiofrequency catheter ablation (RFCA) using a contact force-guided system to isolate certain sections of the hearts in adult horses. The purpose of these isolations is to treat a specific heart condition, atrial tachycardia, by isolating the sections that potentially trigger it. The trial was only run in the short term, however, future studies would be necessary to determine long-term outcomes.

Research Objective

  • Examining if it’s feasible to use a 3D electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA) to isolate particular parts of a horse’s heart. These structures include the caudal vena cava and pulmonary veins, suspected of causing types of arrhythmias (abnormal heartbeats) such as atrial tachycardia and atrial fibrillation.

Methodology

  • The researchers conducted experimental trials on five adult horses that did not report any cardiovascular disease.
  • The horses underwent general anesthesia, and the researchers used a device called CARTO®3 to guide the process.
  • The researchers delivered radiofrequency energy in a power-controlled method with a target power of 45W and irrigation rate of 30ml/min, intending to achieve an ablation-index of 450-500.
  • A point-by-point RFCA approach was employed to isolate the caudal vena cava and the pulmonary veins.

Results

  • The results confirmed successful isolation of the required areas, particularly the myocardial sleeves in the right atrium of the horse’s heart.
  • In the left atrium, the researchers were able to isolate specific parts as well, such as ostium II and ostium III en bloc.
  • The successful isolation was confirmed through what is known as entrance and exit block – information about electrical activity that shows the treated area is correctly isolated.

Conclusions

  • The horses were euthanized after the procedure, meaning the research was unable to monitor for potential reconnection of the isolated veins or determine long-term effects.
  • This study was the first to describe using 3D EAM and RFCA with CARTO®3 in horses, showing its technical feasibility and potential ability to improve treatment for cardiac arrhythmias in horses.
  • Consequently, the experiments successfully demonstrated that using a CF measurement allowed proper monitoring of catheter-tissue contact, culminating in efficient lesion creations (indicative of successful isolation).

Cite This Article

APA
Buschmann E, Van Steenkiste G, Duytschaever M, Boussy T, Vernemmen I, Ibrahim L, Schauvliege S, Decloedt A, van Loon G. (2023). Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro-anatomical mapping and a contact force-guided ablation system. Equine Vet J, 56(5), 1068-1076. https://doi.org/10.1111/evj.14037

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 56
Issue: 5
Pages: 1068-1076

Researcher Affiliations

Buschmann, Eva
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Van Steenkiste, Glenn
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Duytschaever, Mattias
  • Department of Cardiology, AZ Sint-Jan, Brugge, Belgium.
Boussy, Tim
  • Department of Cardiology, AZ Groeninge, Kortrijk, Belgium.
Vernemmen, Ingrid
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Ibrahim, Lara
  • Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium.
Schauvliege, Stijn
  • Department of Large Animal Surgery, Anaesthesia and Orthopaedics, Ghent University, Merelbeke, Belgium.
Decloedt, Annelies
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
van Loon, Gunther
  • Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.

MeSH Terms

  • Animals
  • Horses
  • Pulmonary Veins / surgery
  • Catheter Ablation / veterinary
  • Catheter Ablation / methods
  • Catheter Ablation / instrumentation
  • Venae Cavae / surgery
  • Vena Cava, Inferior / surgery
  • Male
  • Female

Grant Funding

  • 01B05818 / Bijzonder Onderzoeksfonds UGent
  • 1S71521N / Fonds Wetenschappelijk Onderzoek
  • 1SE9122N / Fonds Wetenschappelijk Onderzoek

References

This article includes 39 references
  1. Vernemmen I, Van Steenkiste G, Dufourni A, Decloedt A, van Loon G. Transvenous electrical cardioversion of atrial fibrillation in horses: horse and procedural factors correlated with success and recurrence.. J Vet Intern Med 2022;36:758–769.
  2. 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.
  3. Van Steenkiste G, De Clercq D, Vera L, Decloedt A, van Loon G. Sustained atrial tachycardia in horses and treatment by transvenous electrical cardioversion.. Equine Vet J 2019;51:634–640.
  4. Poole JE, Bahnson TD, Monahan KH, Johnson G, Rostami H, Silverstein AP. Recurrence of atrial fibrillation after catheter ablation or antiarrhythmic drug therapy in the CABANA trial.. J Am Coll Cardiol 2020;75:3105–3118.
  5. Van Steenkiste G, Boussy T, Duytschaever M, Vernemmen I, Schauvlieghe S, Decloedt A. Detection of the origin of atrial tachycardia by 3D electro‐anatomical mapping and treatment by radiofrequency catheter ablation in horses.. J Vet Intern Med 2022;36:1481–1490.
  6. Issa ZM, Miller JM, Zipes DP. Ablation energy sources.. Clinical arrhythmology and electrophysiology 3rd ed. Philadelphia, PA: Elsevier; 2019. p. 206–237.
  7. Jeon WK, Lee SR, Choi EK, Oh S. Clinical outcomes in patients with persistent atrial fibrillation after technologic advances including contact force‐guided and ablation index‐guided ablation.. Int J Arrhythm 2022;23:1–9.
  8. Ariyarathna N, Kumar S, Thomas SP, Stevenson WG, Michaud GF. Role of contact force sensing in catheter ablation of cardiac arrhythmias evolution or history repeating itself?. JACC Clin Electrophysiol 2018;4:707–723.
  9. Buschmann E, Van Steenkiste G, Boussy T, Vernemmen I, Schauvliege S, Decloedt A. Three‐dimensional electro‐anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: a case report.. J Vet Intern Med 2023;37:728–734.
  10. Metzner A, Kuck KH, Chun JKR. What we have learned: is pulmonary vein isolation still the cornerstone of atrial fibrillation ablation?. Europace 2022;24:8–13.
  11. Ibrahim L, Vanhove C, Descamps B, van Loon G, Cornillie P. Morphology of myocardial sleeves in the caudal vena cava of the horse heart (abstract).. Anat Histol Embryol 2022;51:3–64.
  12. Vandecasteele T, Van den Broeck W, Tay H, Couck L, van Loon G, Cornillie P. 3D reconstruction of the porcine and equine pulmonary veins, supplemented with the identification of telocytes in the horse.. Anat Histol Embryol 2018;47:145–152.
  13. Linz D, Hesselkilde E, Kutieleh R, Jespersen T, Buhl R, Sanders P. Pulmonary vein firing initiating atrial fibrillation in the horse: oversized dimensions but similar mechanisms.. J Cardiovasc Electr 2020;31:1211–1212.
  14. Van Steenkiste G, De Clercq D, Boussy T, Vera L, Schauvliege S, Decloedt A. Three dimensional ultra‐high‐density electro‐anatomical cardiac mapping in horses: methodology.. Equine Vet J 2020;52:765–772.
  15. Vernemmen I, Van Steenkiste G, Buschmann E, Schauvliege S, Cornelis K, Decloedt A. Transseptal puncture guided by intracardiac ultrasound to access the left atrium in adult horses (abstract).. ECEIM Congress, Rome 2022.
  16. Vernemmen I, Van Steenkiste G, Buschmann E, Schauvliege S, Cornelis K, Decloedt A. Transseptal puncture in the horse using intracardiac ultrasound guidance: first results with follow‐up (abstract).. J Vet Intern Med 2023.
  17. De Clercq D, van Loon G, Schauvliege S, Tavernier R, Baert K, Croubels S. Transvenous electrical cardioversion of atrial fibrillation in six horses using custom made cardioversion catheters.. Vet J 2008;177:198–204.
  18. Van Steenkiste G, Vera L, Decloedt A, Schauvliege S, Boussy T, van Loon G. Endocardial electro‐anatomic mapping in healthy horses: Normal sinus impulse propagation in the left and right atrium and the ventricles.. Vet J 2020;258:105452.
  19. Nie ZN, Chen SW, Lin JY, Lin JX, Dai SM, Zhang CY. Inferior vena cava as a trigger for paroxysmal atrial fibrillation incidence, characteristics, and implications.. JACC Clin Electrophysiol 2022;8:983–993.
  20. Madrid AH, del Rey JM, Rubi J, Ortega J, Gonzalez Rebollo JM, Seara JG. Biochemical markers and cardiac troponin I release after radiofrequency catheter ablation: approach to size of necrosis.. Am Heart J 1998;136:948–955.
  21. Emkanjoo Z, Mottadayen M, Givtaj N, Alasti M, Arya A, Haghjoo M. Evaluation of post‐radiofrequency myocardial injury by measuring cardiac troponin I levels.. Int J Cardiol 2007;117:173–177.
  22. Martin AC, Kyheng M, Foissaud V, Duhamel A, Marijon E, Susen S. Activated clotting time monitoring during atrial fibrillation catheter ablation: does the anticoagulant matter?. J Clin Med 2020;9(2):350.
  23. Ren JF, Marchlinski FE, Callans DJ. Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography.. J Am Coll Cardiol 2004;43:1861–1867.
  24. Dallap Schaer B, Wilkins PA, Boston R, Palmer J. Preliminary evaluation of hemostasis in neonatal foals using a viscoelastic coagulation and platelet function analyzer: original study.. J Vet Emerg Crit Care 2009;19:81–87.
  25. DeNotta SL, Brooks MB. Coagulation assessment in the equine patient.. Vet Clin N Am‐Equine 2020;36:53–71.
  26. Levy JM, Bleeding A. Hemostasis, and transfusion medicine.. Cardiothoracic critical care Philadelphia, PA: Elsevier; 2007. p. 437–460.
  27. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary.. Heart Rhythm 2017;14:E445–E494.
  28. Issa ZM, Miller JM, Zipes DP. Advanced mapping and navigation modalities.. Clinical arrhythmology and electrophysiology 3rd ed. Philadelphia, PA: Elsevier; 2019. p. 155–205.
  29. Rodriguez‐Manero M, Valderrabano M, Baluja A, Kreidieh O, Martinez‐Sande JL, Garcia‐Seara J. Validating left atrial low voltage areas during atrial fibrillation and atrial flutter using multielectrode automated electroanatomic mapping.. JACC Clin Electrophysiol 2018;4:1541–1552.
  30. Mulder MJ, Kemme MJB, Allaart CP. Radiofrequency ablation to achieve durable pulmonary vein isolation.. Europace 2022;24:874–886.
  31. Santilli RA, Ramera L, Perego M, Moretti P, Spadacini G. Radiofrequency catheter ablation of atypical atrial flutter in dogs.. J Vet Cardiol 2014;16:9–17.
  32. Gianni CS, Al‐Ahmad A, Burhardt J, Horton R, Hranitzky P, Sanchez J. Pulmonary vein isolation for atrial fibrillation.. Catheter ablation of cardiac arrhythmias Philadelphia, PA: Elsevier; 2019 pp. 222–234.
  33. Teres C, Soto‐Iglesias D, Penela D, Jauregui B, Ordonez A, Chauca A. Personalized paroxysmal atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: the ‘Ablate by‐LAW’ single‐centre study‐a pilot study.. Europace 2022;24:390–399.
  34. Inoue J, Skanes AC, Gula LJ, Drangova M. Effect of left atrial wall thickness on radiofrequency ablation success.. J Cardiovasc Electr 2016;27:1298–1303.
  35. Mulder MJ, Kemme MJB, Hagen AMD, Hopman LHGA, van de Ven PM, Hauer HA. Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after ablation index‐guided atrial fibrillation ablation.. IJC Heart Vasc 2020;29:100574.
  36. Taghji P, El Haddad M, Phlips T, Wolf M, Knecht S, Vandekerckhove Y. Evaluation of a strategy aiming to enclose the pulmonary veins with contiguous and optimized radiofrequency lesions in paroxysmal atrial fibrillation a pilot study.. JACC Clin Electrophysiol 2018;4:99–108.
  37. Hussein A, Das M, Chaturvedi V, Asfour IK, Daryanani N, Morgan M. Prospective use of ablation index targets improves clinical outcomes following ablation for atrial fibrillation.. J Cardiovasc Electropyshiol 2017;28:1037–1047.
  38. Phlips T, Taghji P, El Haddad M, Wolf M, Knecht S, Vandekerckhove Y. Improving procedural and one‐year outcome after contact force‐guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’‐protocol.. Europace 2018;20:F419–F427.
  39. Vandecasteele T, Schauvliege S, Boussy T, Philpott M, Clement E, Vera L. Immunohistochemical identification of stent‐based ablation lesions in the superior vena cava and pulmonary veins.. J Histol Histopathol 2017;4:1–6.
Subscribe to our newsletter
Join 99,357 horse owners like you who receive our email updates on horse health and nutrition.