Transvenous electrical cardioversion of equine atrial fibrillation: technical considerations.
Abstract: Conventional treatment of equine atrial fibrillation (AF) involves administration of quinidine salts. Most uncomplicated cases respond to treatment, but pharmacologic cardioversion involves a range of adverse effects, and some horses are unable to tolerate medication. A study was undertaken to develop transvenous electrical cardioversion (TVEC) as an alternative treatment. Safety issues and catheter placement techniques with catheter-integrated cardioversion electrodes were investigated, and responses to shock application were evaluated. After the premortem catheterization of elective-euthanasia horses, no tissue abnormalities were detected at postmortem examination. To evaluate the response to the application of shocks and appropriate electrode positions, an electrical cardioversion of research horses in chronic AF was then attempted. After catheterization of the right atrium (RA) and pulmonary artery through the right jugular vein, horses were placed under general anesthesia. Biphasic, truncated exponential shock waves were delivered at incremental energies until cardioversion was achieved or until a maximum energy of 300 J was reached. Five treatment events were applied to 3 horses, with cardioversion achieved in one of the treatment events. No adverse effects of cardioversion attempts or general anesthesia were observed. The procedure was then applied to 8 client-owned horses, with cardioversion achieved in 7. No adverse responses to appropriately delivered shocks were observed. No antiarrhythmic medications were administered to any horse at any stage. Catheter design and placement technique evolved throughout the study, with combined ultrasonography and pressure guidance proving most effective in achieving appropriate electrode placement. Results suggest TVEC, as applied in the present study, is a safe, effective, and realistic therapeutic option for equine AF.
Publication Date: 2005-10-20 PubMed ID: 16231714DOI: 10.1892/0891-6640(2005)19[695:tecoea]2.0.co;2Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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This study aimed to develop and test a new way to treat a type of heart condition in horses called atrial fibrillation, which currently relies on drug treatments that some horses tolerate poorly. The alternative treatment, transvenous electrical cardioversion, was tested on both euthanized and live horses for safety and effectiveness, showing promising results.
Study Methodology and Findings
- The researchers performed this experiment on horses, where some were euthanized and some were still alive, affected by atrial fibrillation (AF), a cardiac condition.
- The study aimed to develop an alternative treatment to the traditional pharmacological treatment (using quinidine salts). The researchers tried to create a safe method using Transvenous Electrical Cardioversion (TVEC), which delivers electrical shocks to correct heart rhythm.
- The technique involved placing catheters integrated with cardioversion electrodes into different parts of the horse’s heart and applying shockwaves to these areas. This was done in stages until heart rhythm became normal or until a maximum energy limit was reached.
- The study team conducted a follow-up examination after the procedure, in which no abnormalities or harm was detected due to the procedure.
Outcome of The Study
- The experiment was conducted five times on three horses, and it was successful once. However, the procedure did not lead to any adverse effects following the failed attempts or due to the anesthesia used during the procedure.
- The researchers then tested this procedure on eight additional horses not involved in the research, which belonged to clients. It successfully worked on seven of these horses, and no negative effects were detected.
- In all cases, no antiarrhythmic drugs were given to the horses at any stage. This is significant as it validates the effectiveness of TVEC as a stand-alone treatment.
Evolution of Technique and Conclusion
- Different techniques of applying and monitoring TVEC evolved throughout the study. The researchers found the most effective way to navigate the catheter was by using a combination of ultrasound and pressure guidance.
- These results suggest that TVEC could be a safe, effective, and feasible alternative treatment for horse atrial fibrillation, particularly for those horses who are unable to tolerate the conventional pharmacological treatment.
Cite This Article
APA
McGurrin MK, Physick-Sheard PW, Kenney DG, Kerr C, Hanna WJ.
(2005).
Transvenous electrical cardioversion of equine atrial fibrillation: technical considerations.
J Vet Intern Med, 19(5), 695-702.
https://doi.org/10.1892/0891-6640(2005)19[695:tecoea]2.0.co;2 Publication
Researcher Affiliations
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
MeSH Terms
- Anesthesia, General / adverse effects
- Anesthesia, General / methods
- Anesthesia, General / veterinary
- Animals
- Atrial Fibrillation / therapy
- Atrial Fibrillation / veterinary
- Cardiac Catheterization / veterinary
- Electric Countershock / adverse effects
- Electric Countershock / methods
- Electric Countershock / veterinary
- Electrocardiography / veterinary
- Electrodes / veterinary
- Horse Diseases / therapy
- Horses
- Safety
- Treatment Outcome
Citations
This article has been cited 5 times.- Kjeldsen ST, Nissen SD, Buhl R, Hopster-Iversen C. Paroxysmal Atrial Fibrillation in Horses: Pathophysiology, Diagnostics and Clinical Aspects. Animals (Basel) 2022 Mar 10;12(6).
- 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 Mar;36(2):758-769.
- McGurrin MKJ. The diagnosis and management of atrial fibrillation in the horse. Vet Med (Auckl) 2015;6:83-90.
- Bozorgmanesh R, Magdesian KG, Estell KE, Stern JA, Swain EA, Griffiths LG. Atrial Fibrillation in Eight New World Camelids. J Vet Intern Med 2016 Jan-Feb;30(1):335-8.
- Reef VB, Bonagura J, Buhl R, McGurrin MK, Schwarzwald CC, van Loon G, Young LE. Recommendations for management of equine athletes with cardiovascular abnormalities. J Vet Intern Med 2014 May-Jun;28(3):749-61.
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