Premature depolarisations in horses competing in United States Eventing Association and Fédération Equestre Internationale-sanctioned 3-day events

Association of heart rate variability, exercise intensity and exercising arrhythmias with competition results in eventing horses

BACKGROUND

Exercising arrhythmias are common in horses participating in eventing competitions. Heart rate variability (HRV) and a specific measure of the degree of heart rate fluctuation (Detrended Fluctuation Analysis alpha1; DFA-α1) are proposed as exercise intensity and fatigue markers.

OBJECTIVES

(1) To describe exercising arrhythmias and DFA-α1 values during 2-4* level eventing cross-country competitions in horses from two European countries; (2) to identify associations between exercising arrhythmias, DFA-α1 and competition results and (3) to evaluate whether markers of the intensity of exercise are associated with exercising arrhythmias, DFA-α1 or competition results.

METHODS

A convenience sample of exercising ECGs and competition results from horses during cross-country eventing competitions was examined. Statistical analysis was conducted using multivariable mixed-effects logistic, Poisson and linear regression models.

RESULTS

Arrhythmias were frequent during 69 cross-country competition ECGs from 43 horses. Detrended fluctuation analysis α1 was not associated with performance during cross-country, but a higher DFA-α1 during cross-country was associated with fewer showjumping phase penalties. More premature complexes, the presence of complex arrhythmias and arrhythmias during recovery were associated with fewer time penalties during cross-country. The presence of complex arrhythmias and arrhythmias during recovery of the cross-country phase was associated with more penalties during the showjumping phase. Higher blood lactate concentration, higher HRpeak and higher HRmean were associated with fewer time penalties during cross-country.

MAIN LIMITATIONS

The arrhythmias observed do not allow conclusions to be drawn about the consequences of more severe arrhythmias. The associations described here were often of small magnitude or with large confidence intervals and must be interpreted cautiously.

CONCLUSIONS

Arrhythmias during the cross-country test of eventing competitions were frequently associated with positive competition results during the cross-country phase and negative results during the showjumping phase. The specific arrhythmia types and circumstances that should raise concern about performance and safety remain relevant but unanswered questions for equine practitioners.

Development of an atrial transseptal puncture procedure in horses to access the left heart: An ultrasound-guided jugular vein and transhepatic approach

BACKGROUND

Radiofrequency ablation has been successfully applied to treat right atrial arrhythmias in horses. Ablation of left-sided arrhythmias requires a retrograde transarterial approach which is complicated. In human medicine, the left atrium is accessed through transseptal puncture (TSP) of the fossa ovalis (FO) using a caudal approach via the femoral vein.

OBJECTIVES

To develop a zero fluoroscopy TSP technique for horses using a jugular vein (cranial) and transhepatic (caudal) approach.

STUDY DESIGN

In vivo experimental study.

METHODS

Transseptal puncture was performed in 18 horses admitted for euthanasia and donated for scientific research under general anaesthesia: using a jugular vein approach (10 horses), a transhepatic approach (2 horses) or both (6 horses). Radiofrequency energy was applied on a guidewire to perforate the FO and allow sheath advancement under intracardiac and transthoracic echocardiographic guidance. Puncture lesions were inspected post-mortem.

RESULTS

Transseptal puncture was successful in 17/18 horses, of which 15/16 jugular vein approaches and 5/8 transhepatic approaches. Failure was due to technical malfunction, inability to advance the guidewire toward the heart and inability to advance the sheath through the FO. Intracardiac echocardiography was essential to safely guide the puncture process. Atrial arrhythmias caused by the TSP occurred in 13/18 horses. Puncture lesions were found in the right atrium in the FO region, and left atrium ventral to pulmonary vein ostium III.

MAIN LIMITATIONS

Because in several horses two approaches were tested consecutively, it cannot be excluded that the second TSP was performed at the previous puncture site. Due to the developmental nature of the study the approaches were not randomised and did not allow comparison.

CONCLUSION

Transseptal puncture is feasible in horses using ultrasound guidance and allows for electrophysiological exploration of the left heart. Further studies are needed to evaluate post-operative follow-up.

Electrocardiograms from different types of exercise in Eventing horses with and without cardiac signs

BACKGROUND

Exercising arrhythmias can be clinically irrelevant or associated with poor performance, collapse and sudden cardiac death.

OBJECTIVES

To test if readable exercising ECGs can be recorded by grooms or riders and to describe arrhythmias in ECGs from different types of exercise in Eventing horses and investigate associations with type of workout, the presence of previous cardiac signs and intensity of exercise.

STUDY DESIGN

Cohort study.

METHODS

Single lead exercising ECGs were obtained by riders or grooms during training and competition from a convenience sample of horses in training for Eventing competitions. Arrhythmias were described, and associations between different arrhythmia categories and variables that described the horse and the workouts were sought.

RESULTS

There were 1002 ECGs from 62 horses (median [range] 7 [2-97] ECGs/horse) evaluated and 737 workouts (73.6%) were >95% readable and included in the analysis. There were arrhythmias in 250 (33.9%) of the workouts, complex arrhythmias in 13 (1.8%) and the number of premature complexes was median (range) 0 (0-118). Peak heart rate and duration of exercise were associated with the number of premature complexes, the presence of arrhythmias and complex arrhythmias and were colinear with the type of exercise. Having previous signs of cardiac disease and the type of workout were associated with higher odds of having arrhythmias.

CONCLUSIONS

Monitoring the rhythm of equine athletes with ECGs obtained by riders and transmitted to an online cloud was feasible. Arrhythmias were frequent, and complex arrhythmias were rare. The presence of cardiac signs, type of exercise and peak heart rate were associated with the presence of arrhythmias. None of the horses developed poor performance or collapse attributed to cardiac disease. The arrhythmias that should be concerning for equine veterinarians need further definition.