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Journal of veterinary internal medicine2022; 36(2); 758-769; doi: 10.1111/jvim.16395

Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence.

Abstract: 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 cumulative amount of energy (≤ 600 J vs > 600 J) were determined using multivariable logistic regression. A survival analysis was performed to determine risk factors for recurrence. Results: Two hundred and thirty-one TVEC procedures were included, with a 94.4% success rate and 31.9% recurrence rate (51/160). Mitral regurgitation (OR 0.151, 95% CI 0.032-0.715, P = .02) and AF cycle length (OR 1.05, 95% CI 1.01-1.09, P = .02) were independent determinants for success. Catheter type (OR 0.154, 95% CI 0.074-0.322, P < .001), previous AF episode (OR 3.10, 95% CI 1.20-8.01, P = .02), tricuspid regurgitation (OR 2.54, 95% CI 1.25-5.13, P = .01), and body weight (OR 1.009, 95% CI 1.003-1.015, P = .004) were significantly correlated with cumulative amount of energy delivered. Significant risk factors for recurrence after a first AF episode were sex (stallion; HR 3.05, 95% CI 1.34-6.95, P = .008), mitral regurgitation (HR 1.91, 95% CI 1.08-3.38, P = .03), and AF duration (HR 1.001, 95% CI 1.0001-1.0026, P = .04). Conclusions: Both horse and procedural factors should be considered when assessing treatment options and prognosis in horses with AF.
© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2022-03-05 PubMed ID: 35246994PubMed Central: PMC8965264DOI: 10.1111/jvim.16395Google Scholar: Lookup
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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 article is about a study conducted to identify factors that impact the success and recurrence rate of transvenous electrical cardioversion (TVEC), a main treatment option for atrial fibrillation (AF) in horses. The study specifically focused on a major Warmblood study sample.

Introduction

The study conducted researched the successful results of transvenous electrical cardioversion (TVEC), one of the primary treatments for atrial fibrillation (AF) in horses. It took into account a predominantly Warmblood sample size and aimed to determine the factors affecting the success and frequency of recurrence post-procedure.

Methodology

  • The study used a sample size of 199 horses and analyzed retrospective data of TVEC procedures.
  • These horses were suffering from AF but did not show severe echocardiographic abnormalities.
  • To identify influencing factors, multivariable logistic regression was utilized considering both the horse’s characteristics and procedure details.
  • The amount of energy used during these procedures was also a major factor considered and two categories were established for analysis: energy less than or equal to 600 J, and energy greater than 600 J.

Results

  • The success rate was notably high, standing at 94.4% out of 231 examined TVEC procedures.
  • The recurrence rate of AF was found to be 31.9% (51 out of 160 cases).
  • In terms of factors influencing success, independent determinants were found to be the presence of mitral regurgitation and the AF cycle length.
  • Determinants correlating with the cumulative amount of energy delivered were catheter type, previous AF episodes, tricuspid regurgitation, and the body weight of the horse.
  • Risk factors for recurrence post-AF episode were identified as sex of the horse (stallions had higher recurrence), mitral regurgitation, and the duration of AF.

Conclusions

In conclusion, the study reinforced the importance of considering both horse-specific and procedural factors when forecasting treatment options and prognosis for horses suffering from AF. Evidently, with certain factors, TVEC procedures had high success rates but risk of recurrence requires further exploration.

Cite This Article

APA
Vernemmen I, Van Steenkiste G, Dufourni A, Decloedt A, van Loon G. (2022). Transvenous electrical cardioversion of atrial fibrillation in horses: Horse and procedural factors correlated with success and recurrence. J Vet Intern Med, 36(2), 758-769. https://doi.org/10.1111/jvim.16395

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 36
Issue: 2
Pages: 758-769

Researcher Affiliations

Vernemmen, Ingrid
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Van Steenkiste, Glenn
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Dufourni, Alexander
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Decloedt, Annelies
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
van Loon, Gunther
  • Equine Cardioteam, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.

MeSH Terms

  • Animals
  • Atrial Fibrillation / therapy
  • Atrial Fibrillation / veterinary
  • Echocardiography / veterinary
  • Electric Countershock / veterinary
  • Horse Diseases / etiology
  • Horse Diseases / therapy
  • Horses
  • Male
  • Recurrence
  • Retrospective Studies

Grant Funding

  • 1S56217N / Fonds Wetenschappelijk Onderzoek

Conflict of Interest Statement

Authors declare no conflict of interest.

References

This article includes 66 references
  1. Reef VB, Bonagura J, Buhl R. Recommendations for management of equine athletes with cardiovascular abnormalities.. J Vet Intern Med 2014;28(3):749‐761.
    pmc: PMC4895474pubmed: 24628586
  2. Else RW, Holmes JR. Pathological changes in atrial fibrillation in the horse.. Equine Vet J 1971;3(2):56‐64.
    pubmed: 5161359
  3. Hindricks G, Potpara T, Dagres N. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS).. Eur Heart J 2021;42(5):373‐498.
    pubmed: 32860505
  4. Reef VB, Levitan CW, Spencer PA. Factors affecting prognosis and conversion in equine atrial fibrillation.. J Vet Intern Med 1988;2(1):1‐6.
    pubmed: 3221350
  5. McGurrin MKJ, 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(3):609‐615.
    pubmed: 18466256
  6. De Clercq D, van Loon G, Schauvliege S. Transvenous electrical cardioversion of atrial fibrillation in six horses using custom made cardioversion catheters.. Vet J 2008;177(2):198‐204.
    pubmed: 17920965
  7. 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(11):1409‐1414.
    pubmed: 29772981
  8. Deem DA, Fregin GF. Atrial fibrillation in horses: a review of 106 clinical cases, with consideration of prevalence, clinical signs, and prognosis.. J Am Vet Med Assoc 1982;180(3):261‐265.
    pubmed: 7056674
  9. 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(7):609‐614.
    pubmed: 15581326
  10. Decloedt A, de Clercq D, van der Vekens N, Verheyen T, van Loon G. Noninvasive determination of atrial fibrillation cycle length by atrial colour tissue Doppler imaging in horses.. Equine Vet J 2014;46(2):174‐179.
    pubmed: 23738919
  11. Van Steenkiste G, Carlson J, Decloedt A. 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;34:73‐79.
    pubmed: 33611234
  12. McGurrin MKJ. The diagnosis and management of atrial fibrillation in the horse.. Vet Med Res Rep 2015;6:83‐90.
    pmc: PMC6067668pubmed: 30101098
  13. McGurrin MKJ, Physick‐Sheard PW, Kenney DG. How to perform transvenous electrical cardioversion in horses with atrial fibrillation.. J Vet Cardiol 2005;7(2):109‐119.
    pubmed: 19083326
  14. McGurrin MKJ, Physick‐Sheard PW, Kenney DG. Transvenous electrical cardioversion of equine atrial fibrillation: technical considerations.. J Vet Intern Med 2005;19(5):695‐702.
    pubmed: 16231714
  15. van Loon G, De Clercq D, Tavernier R. Transient complete atrioventricular block following transvenous electrical cardioversion of atrial fibrillation in a horse.. Vet J 2005;170(1):124‐127.
    pubmed: 15993796
  16. Johnston GM, Eastment JK, Wood JLN, Taylor PM. The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of phases 1 and 2.. Vet Anaesth Analg 2002;29(4):159‐170.
    pubmed: 28404360
  17. Reef VB, Reimer JM, Spencer PA. Treatment of atrial fibrillation in horses: new perspectives.. J Vet Intern Med 1995;9(2):57‐67.
    pubmed: 7760311
  18. Decloedt A, Van Steenkiste G, Vera L. Atrial fibrillation in horses part 2: diagnosis, treatment and prognosis.. Vet J 2021;268:105594.
    pubmed: 33468306
  19. Vernemmen I, Vera L, Van Steenkiste G. Reference values for 2‐dimensional and M‐mode echocardiography in Friesian and Warmblood horses.. J Vet Intern Med 2020;34(6):2701‐2709.
    pmc: PMC7694853pubmed: 33098342
  20. Ven S, Decloedt A, Van Der Vekens N. Assessing aortic regurgitation severity from 2D, M‐mode and pulsed wave Doppler echocardiographic measurements in horses.. Vet J 2016;210:34‐38.
    pubmed: 26900009
  21. De Clercq D, van Loon G, Tavernier R. 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(6):1353‐1359.
    pubmed: 19000247
  22. Decloedt A, De Clercq D, Ven S. Echocardiographic measurements of right heart size and function in healthy horses.. Equine Vet J 2017;49(1):58‐64.
    pubmed: 26729051
  23. Marr CM, Patteson M. Echocardiography.. In: Marr CM, Bowen M, eds. Cardiology of the Horse. 2nd ed. London, UK: Saunders Elsevier; 2010:105‐126.
  24. Schwarzwald CC. Equine echocardiography.. Vet Clin North Am Equine Pract 2019;35(1):43‐64.
    pubmed: 30826106
  25. De Clercq D, Decloedt A, Sys SU. 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(2):624‐629.
    pmc: PMC4858013pubmed: 24611990
  26. Decloedt A, De Clercq D, Van Der Vekens N. 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(1):21‐26.
    pubmed: 25266765
  27. Wijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats.. Circulation 1995;92(7):1954‐1968.
    pubmed: 7671380
  28. Yu WC, Lee SH, Tai CT. Reversal of atrial electrical remodeling following cardioversion of long‐standing atrial fibrillation in man.. Cardiovasc Res 1999;42(2):470‐476.
    pubmed: 10533582
  29. Everett TH IV, Li H, Mangrum JM. Electrical, morphological, and ultrastructural remodeling and reverse remodeling in a canine model of chronic atrial fibrillation.. Circulation 2000;102(12):1454‐1460.
    pubmed: 10993867
  30. Austin PC, White IR, Lee DS, van Buuren S. Missing data in clinical research: a tutorial on multiple imputation.. Can J Cardiol 2021;37(9):1322‐1331.
    pmc: PMC8499698pubmed: 33276049
  31. Gehlen H, Stadler P. Atrial fibrillation in warmblood horses—echocardiography, therapy, prognosis and outcome in 72 cases.. Pferdeheilkd Equine Med 2002;18(6):530‐536.
  32. Goltz A, Gehlen H, Rohn K, Stadler P. Therapy of atrial fibrillation with class‐1A and class‐1C antiarrhythmic agents and ACE inhibitors.. Pferdeheilkd Equine Med 2009;25(3):220‐227.
  33. Decloedt A, Van Steenkiste G, Vera L. Atrial fibrillation in horses part 1: pathophysiology.. Vet J 2020;263:105521.
    pubmed: 32928494
  34. Bollmann A, Mende M, Neugebauer A. Atrial fibrillatory frequency predicts atrial defibrillation threshold and early arrhythmia recurrence in patients undergoing internal cardioversion of persistent atrial fibrillation.. Pacing Clin Electrophysiol 2002;25(8):1179‐1184.
    pubmed: 12358167
  35. Everett TH, Li H, Mangrum JM. The effects of atrial electrical remodeling on atrial defibrillation thresholds.. Pacing Clin Electrophysiol 2001;24(8):1208‐1215.
    pubmed: 11523605
  36. Everett TH, Wilson EE, Olgin JE. Effects of atrial fibrillation substrate and spatiotemporal organization on atrial defibrillation thresholds.. Hear Rhythm 2007;4(8):1048‐1056.
    pubmed: 17675080
  37. Preiss EE, Kenney DG, McGurrin MKJ. Influence of electrode position on cardioversion energy requirements during transvenous electrical cardioversion in horses.. Am J Vet Res 2011;72(9):1193‐1203.
    pubmed: 21879977
  38. van Loon G, Van Steenkiste G, Vera L. Catheter‐based electrical interventions to study, diagnose and treat arrhythmias in horses: from refractory period to electro‐anatomical mapping.. Vet J 2020;263:105519.
    pubmed: 32928488
  39. van Loon G. Dysrhythmias: cardiac pacing and electrical cardioversion.. In: Marr CM, Bowen M, eds. Cardiology of the Horse. 2nd ed. London, UK: Saunders Elsevier; 2010:179‐192.
  40. Kalman JM, Power JM, Chen JM, Farish SJ, Tonkin AM. Importance of electrode design, lead configuration and impedance for successful low energy transcatheter atrial defibrillation in dogs.. J Am Coll Cardiol 1993;22(4):1199‐1206.
    pubmed: 8409061
  41. Decloedt A, Schwarzwald CC, De Clercq D. Risk factors for recurrence of atrial fibrillation in horses after cardioversion to sinus rhythm.. J Vet Intern Med 2015;29(3):946‐953.
    pmc: PMC4895430pubmed: 25917409
  42. Vernemmen I, De Clercq D, Decloedt A. Atrial premature depolarisations five days post electrical cardioversion are related to atrial fibrillation recurrence risk in horses.. Equine Vet J 2020;52(3):374‐378.
    pubmed: 31583742
  43. van Loon G, Tavernier R, Duytschaever M. Pacing induced sustained atrial fibrillation in a pony.. Can J Vet Res 2000;64(4):254‐258.
    pmc: PMC1189629pubmed: 11041507
  44. Hesselkilde EZ, Carstensen H, Flethøj M. Longitudinal study of electrical, functional and structural remodelling in an equine model of atrial fibrillation.. BMC Cardiovasc Disord 2019;19(1):228.
    pmc: PMC6805623pubmed: 31638896
  45. Tse H‐F, Lau CP. Clinical predictors and time course of arrhythmia recurrence in patients with early reinitiation of atrial fibrillation after successful internal cardioversion.. Pacing Clin Electrophysiol 2003;26(9):1809‐1814.
    pubmed: 12930494
  46. Duytschaever M, Danse P, Allessie M. Supervulnerable phase immediately after termination of atrial fibrillation.. J Cardiovasc Electrophysiol 2002;13(3):267‐275.
    pubmed: 11942596
  47. Timmermans C, Rodriguez L‐M, Smeets JLRM. Immediate reinitiation of atrial fibrillation following internal atrial defibrillation.. J Cardiovasc Electrophysiol 1998;9(2):122‐128.
    pubmed: 9511886
  48. Lee SH, Tai CT, Hsieh MH. Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation.. J Interv Card Electrophysiol 2004;10(3):221‐226.
    pubmed: 15133358
  49. Lau C‐P, Tse H‐F, Ayers GM. Defibrillation‐guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus.. J Am Coll Cardiol 1999;33(5):1217‐1226.
    pubmed: 10193719
  50. Tse HF, Oral H, Pelosi F. Effect of gender on atrial electrophysiologic changes induced by rapid atrial pacing and elevation of atrial pressure.. J Cardiovasc Electrophysiol 2001;12(9):986‐989.
    pubmed: 11573707
  51. Bidoggia H, Maciel JP, Capalozza N. Sex differences on the electrocardiographic pattern of cardiac repolarization: possible role of testosterone.. Am Heart J 2000;140(4):678‐683.
    pubmed: 11011345
  52. Liu X‐K, Katchman A, Drici M‐D. Gender difference in the cycle length‐dependent QT and potassium currents in rabbits.. J Pharmacol Exp Ther 1998;285:672‐679.
    pubmed: 9580612
  53. Pham TV, Robinson RB, Danilo P. Effects of gonadal steroids on gender‐related differences in transmural dispersion of L‐type calcium current.. Cardiovasc Res 2002;53(3):752‐762.
    pubmed: 11861045
  54. Gurevitz OT, Varadachari CJ, Ammash NM. The effect of patient sex on recurrence of atrial fibrillation following successful direct current cardioversion.. Am Heart J 2006;152(1):155.e9‐155.e13.
    pubmed: 16824847
  55. Fenger‐Grøn M, Overvad K, Tjønneland A, Frost L. Lean body mass is the predominant anthropometric risk factor for atrial fibrillation.. J Am Coll Cardiol 2017;69(20):2488‐2497.
    pubmed: 28521886
  56. Fonseca RG, Kenny DA, Hill EW, Katz LM. The relationship between body composition, training and race performance in a group of Thoroughbred flat racehorses.. Equine Vet J 2013;45(5):552‐557.
    pubmed: 23294231
  57. Slusser WN, Wade GN. Testicular effects on food intake, body weight, and body composition in male hamsters.. Physiol Behav 1981;27(4):637‐640.
    pubmed: 7323166
  58. Christoffersen BO, Gade LP, Golozoubova V, Svendsen O, Raun K. Influence of castration‐induced testosterone and estradiol deficiency on obesity and glucose metabolism in male Göttingen minipigs.. Steroids 2010;75(10):676‐684.
    pubmed: 20420845
  59. Decloedt A, Verheyen T, Van Der Vekens N. Long‐term follow‐up of atrial function after cardioversion of atrial fibrillation in horses.. Vet J 2013;197(3):583‐588.
    pubmed: 23823082
  60. De Clercq D, van Loon G, Baert K. Intravenous amiodarone treatment in horses with chronic atrial fibrillation.. Vet J 2006;172(1):129‐134.
    pubmed: 15908245
  61. Gill J, Heel RC, Fitton A. Amiodarone: an overview of its pharmacological properties, and review of its therapeutic use in cardiac arrhythmias.. Drugs 1992;43(1):69‐110.
    pubmed: 1372862
  62. Capucci A, Villani GQ, Aschieri D, Rosi A, Piepoli MF. Oral amiodarone increases the efficacy of direct‐current cardioversion in restoration of sinus rhythm in patients with chronic atrial fibrillation.. Eur Heart J 2000;21(1):66‐73.
    pubmed: 10610746
  63. Gorenek B, Cavusoglu Y, Goktekin O. Amiodarone versus Sotalol and Propafenone for prevention of immediate recurrence of atrial fibrillation after internal cardioversion: importance of P wave analysis.. Int J Cardiol 2006;106(2):268‐269.
    pubmed: 16321704
  64. Broux B, De Clercq D, Decloedt A. Pharmacokinetics and electrophysiological effects of sotalol hydrochloride in horses.. Equine Vet J 2018;50(3):377‐383.
    pubmed: 29023952
  65. Decloedt A, Broux B, De Clercq D. Effect of sotalol on heart rate, QT interval, and atrial fibrillation cycle length in horses with atrial fibrillation.. J Vet Intern Med 2018;32(2):815‐821.
    pmc: PMC5866983pubmed: 29460446
  66. Singh BN, Singh SN, Reda DJ. Amiodarone versus Sotalol for atrial fibrillation.. N Engl J Med 2005;352(18):1861‐1872.
    pubmed: 15872201

Citations

This article has been cited 3 times.
  1. Natterson-Horowitz B, Wright K, Van Steenkiste G, Decloedt A, Gagnon AL, Cai X, Mazmanian A. Arrhythmias across the tree of life: comparative insights for human electrophysiology. Front Cardiovasc Med 2025;12:1652591.
    doi: 10.3389/fcvm.2025.1652591pubmed: 41567384google scholar: lookup
  2. Nath LC, Elliott A, La Gerche A, Weir J, Forbes G, Thomas G, Franklin S. Associations between postrace atrial fibrillation and measures of performance, racing history and airway disease in horses. J Vet Intern Med 2023 Nov-Dec;37(6):2573-2583.
    doi: 10.1111/jvim.16878pubmed: 37740606google scholar: lookup
  3. Van Steenkiste G, Boussy T, Duytschaever M, Vernemmen I, Schauvlieghe S, Decloedt A, van Loon G. 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 Jul;36(4):1481-1490.
    doi: 10.1111/jvim.16473pubmed: 35686355google scholar: lookup
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