Treatment of lidocaine-refractory ventricular tachycardia using procainamide in an anesthetized horse.
Abstract: To highlight the use of procainamide as a potential alternative treatment modality in cases of ventricular tachycardia that are refractory to lidocaine and magnesium sulfate. Methods: 1 adult horse weighing 380 kg. Unassigned: A 25-year-old Arabian gelding presented with severe colic signs. Due to persistent pain, it was elected to carry out an exploratory laparotomy. During the procedure a diagnosis of severe, unstable ventricular tachycardia was made based on the ECG findings, with an initial heart rate of 195 beats per minute and severe hypotension. Results: Initial treatment consisted of discontinuing dobutamine and the administration of a 2 mg/kg IV lidocaine bolus followed by a continuous rate infusion at 50 μg/kg/min. Twenty grams magnesium sulfate (5 mg/kg) was administered IV in 1 L of lactated Ringer solution as a slow bolus over 30 minutes. Ventricular tachycardia persisted with poor peripheral pulses, a severely dampened arterial waveform, and a MAP of 30 to 45 mm Hg. Two milligrams/kg IV procainamide was administered over 3 minutes, 3 separate times, at 5-minute intervals. Immediately following the third dose sinus rhythm was detected on the ECG, the arterial waveform improved, and MAP increased to 85 mm Hg. Conclusions: Ventricular tachycardia is a rare but potentially life-threatening complication in horses undergoing general anesthesia. The potential of this arrhythmia to progress to ventricular fibrillation is of grave concern, as the option to attempt to externally defibrillate horses back to normal sinus rhythm does not exist. This case highlights procainamide as a potential option for cases of ventricular tachycardia that are refractory to more standard treatment modalities.
Publication Date: 2024-02-09 PubMed ID: 38335722DOI: 10.2460/javma.23.09.0535Google Scholar: Lookup
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Summary
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This study demonstrates the successful use of procainamide, an anti-arrhythmic drug, to treat a case of life-threatening ventricular tachycardia (a type of heart rhythm disorder) that was not responding to standard treatments in an anesthetized horse.
Introduction
- This research is about ventricular tachycardia, an abnormal heart rhythm that characterized by a racing heart beat and which was observed in an anesthetized horse during an exploratory laparotomy.
- The abnormal heart rhythm did not respond to the standard treatment methods of lidocaine and magnesium sulfate, leading to the experimental use of procainamide, an anti-arrhythmic medication.
Methods
- The subject of study was a 25-year-old Arabian gelding that weighted 380 kg and presented with severe colic, a common digestive disorder in horses.
- The horse displayed severe ventricular tachycardia based on ECG findings during a laparotomy and was initially hypotensive.
- The standard treatment of a lidocaine bolus and a continuous infusion, as well as magnesium sulfate, did not correct the cardiac arrhythmia.
Results
- To combat persisting ventricular tachycardia, procainamide was administered intravenously three times, at 5-minute intervals.
- Following the third dose of procainamide, it was observed on the ECG that the horse’s heart had returned to the sinus rhythm, normal rhythm. The arterial waveform improved and the horse’s blood pressure increased significantly.
Conclusion
- Ventricular tachycardia is rare but a potential life-threatening complication in horses undergoing general anesthesia. Lack of external defibrillation options in horses makes dealing with this issue even more challenging.
- This case study provides strong evidence of the potential use of procainamide as an alternative treatment for ventricular tachycardia in horses, especially when traditional treatments are inefficacious.
Cite This Article
APA
Fernandez-Barrientos MA, Flynn H, Ratliff B, Kilcoyne I.
(2024).
Treatment of lidocaine-refractory ventricular tachycardia using procainamide in an anesthetized horse.
J Am Vet Med Assoc, 262(5), 1-3.
https://doi.org/10.2460/javma.23.09.0535 Publication
Researcher Affiliations
- 1William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA.
- 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA.
- 1William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA.
- 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA.
MeSH Terms
- Animals
- Horses
- Procainamide / therapeutic use
- Tachycardia, Ventricular / veterinary
- Tachycardia, Ventricular / drug therapy
- Horse Diseases / drug therapy
- Lidocaine / therapeutic use
- Male
- Anti-Arrhythmia Agents / therapeutic use
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