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Avison A, Gelzer AR, Reef VB, Wulster Bills KB, de Solis CN, Kraus MS, Slack J, Stefanovski D, Deacon LJ, Underwood C. Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses. J Vet Intern Med 2024; 38:1751-1764. [PMID: 38514200 PMCID: PMC11099695 DOI: 10.1111/jvim.17027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. OBJECTIVE To describe temporary, medium-term (24 h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. ANIMALS Six healthy adult institutional teaching horses. METHODS Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24 h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6 h, and pacing thresholds were recorded every 6 h. Pacing failure was defined as a period of loss of capture longer than 20 s. RESULTS Pacing leads were placed with both guidance methods and maintained for 24 h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P < 0.05. CONCLUSIONS AND CLINICAL IMPORTANCE Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.
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Affiliation(s)
- Amanda Avison
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Anna R. Gelzer
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Virginia B. Reef
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Kathryn B. Wulster Bills
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Cris Navas de Solis
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Marc S. Kraus
- Department of Clinical Sciences and Advanced MedicineSchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - JoAnn Slack
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Lindsay J. Deacon
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
| | - Claire Underwood
- Department of Clinical Studies, New Bolton CenterSchool of Veterinary Medicine, University of PennsylvaniaKennett SquarePennsylvaniaUSA
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Flanders WH, Moïse NS, Otani NF. Use of machine learning and Poincaré density grid in the diagnosis of sinus node dysfunction caused by sinoatrial conduction block in dogs. J Vet Intern Med 2024; 38:1305-1324. [PMID: 38682817 PMCID: PMC11099791 DOI: 10.1111/jvim.17071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Sinus node dysfunction because of abnormal impulse generation or sinoatrial conduction block causes bradycardia that can be difficult to differentiate from high parasympathetic/low sympathetic modulation (HP/LSM). HYPOTHESIS Beat-to-beat relationships of sinus node dysfunction are quantifiably distinguishable by Poincaré plots, machine learning, and 3-dimensional density grid analysis. Moreover, computer modeling establishes sinoatrial conduction block as a mechanism. ANIMALS Three groups of dogs were studied with a diagnosis of: (1) balanced autonomic modulation (n = 26), (2) HP/LSM (n = 26), and (3) sinus node dysfunction (n = 21). METHODS Heart rate parameters and Poincaré plot data were determined [median (25%-75%)]. Recordings were randomly assigned to training or testing. Supervised machine learning of the training data was evaluated with the testing data. The computer model included impulse rate, exit block probability, and HP/LSM. RESULTS Confusion matrices illustrated the effectiveness in diagnosing by both machine learning and Poincaré density grid. Sinus pauses >2 s differentiated (P < .0001) HP/LSM (2340; 583-3947 s) from sinus node dysfunction (8503; 7078-10 050 s), but average heart rate did not. The shortest linear intervals were longer with sinus node dysfunction (315; 278-323 ms) vs HP/LSM (260; 251-292 ms; P = .008), but the longest linear intervals were shorter with sinus node dysfunction (620; 565-698 ms) vs HP/LSM (843; 799-888 ms; P < .0001). CONCLUSIONS Number and duration of pauses, not heart rate, differentiated sinus node dysfunction from HP/LSM. Machine learning and Poincaré density grid can accurately identify sinus node dysfunction. Computer modeling supports sinoatrial conduction block as a mechanism of sinus node dysfunction.
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Affiliation(s)
- Wyatt Hutson Flanders
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - N. Sydney Moïse
- Section of Cardiology, Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Niels F. Otani
- School of Mathematical SciencesRochester Institute of TechnologyRochesterNew YorkUSA
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McManamey AK, Lake MM, DeFrancesco TC. Cardiovascular images: pacemaker-lead fracture and excessive coiling in a dog. J Vet Cardiol 2024; 52:68-71. [PMID: 38432142 DOI: 10.1016/j.jvc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
A seven-year-old male castrated Labrador Retriever presented emergently due to concern for pacemaker malfunction five years after successful transvenous pacemaker implantation to treat partial atrial standstill. On presentation, the dog's pulse rate was 30-50 beats per minute. An electrocardiogram showed no spontaneous atrial activity or paced ventricular activity. Pacemaker interrogation revealed an increased impedance of 7557 ohms, indicating a lead malfunction. Thoracic radiographs confirmed the lead was fractured and had excessive coiling. The transvenous pacing system was turned off, left in place, and an epicardial pacing system was implanted the following day. The dog was discharged with no perioperative complications. The dog eventually required escalated medical therapy for progressive cardiac disease and was euthanized two years after implantation of the replacement pacemaker. This manuscript illustrates a complete lead fracture and excessive lead coiling, which has not previously been detailed in veterinary medicine.
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Affiliation(s)
- A K McManamey
- Department Veterinary Clinical Services, College of Veterinary Medicine, Purdue University, 625 Harrison Street, West Lafayette, IN 47907, USA; Department of Clinical Science, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA.
| | - M M Lake
- Department of Clinical Science, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA; Columbus Emergency Vet and Specialty Care, 300 East Wilson Bridge Road, Worthington, OH, 43085, USA
| | - T C DeFrancesco
- Department of Clinical Science, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27606, USA
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Jeong HW, Menciotti G. Insulation break of the ventricular lead in a dog with a pacemaker. J Vet Cardiol 2023; 50:63-68. [PMID: 37931345 DOI: 10.1016/j.jvc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023]
Abstract
A 10-year-old female spayed mixed breed dog that had a transvenous pacemaker implanted four years prior was presented for the evaluation of episodes of transient loss of consciousness without any history of trauma that were unresponsive to anticonvulsant therapies. Intermittent failure to capture coupled with low impedance and high capture threshold were noted upon interrogation of the pacemaker. Radiography and fluoroscopy demonstrated a possible break in the insulation of the lead. After the placement of another transvenous pacemaker, the dog had no additional syncopal episodes, and anticonvulsants were tapered off. The dog developed an implant infection from the newly placed pacemaker, which prompted the removal of the infected pacemaker and the implantation of an epicardial pacemaker. However, the epicardial lead dislodged seven days after placement, and the dog was euthanized. During necropsy, the first transvenous lead was removed, and the insulation break was visually confirmed. Although an insulation break is a rare delayed complication of pacemaker implantation, this report shows how the diagnosis, suspected by typical interrogation findings, can be aided by radiographic and fluoroscopic investigations.
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Affiliation(s)
- H W Jeong
- Department Small Animal Clinical Science, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, USA.
| | - G Menciotti
- Department Small Animal Clinical Science, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, USA
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Köster LS, Zhu X, Smith CK, Aisa J. Single center retrospective clinical audit and comparison of outcome between epicardial and transvenous endocardial permanent pacemaker implantations in dogs. PLoS One 2023; 18:e0290029. [PMID: 38015932 PMCID: PMC10683988 DOI: 10.1371/journal.pone.0290029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/01/2023] [Indexed: 11/30/2023] Open
Abstract
The aim of this retrospective cohort study was to provide a single-center clinical audit of complications for single chamber permanent pacemaker implantation (PPI) techniques and determine if the clinical parameters, PPI technique or complications were associated with outcome. The electronic medical records were searched for dogs treated for bradyarrhythmia with PPI. Data related to presenting complaint, signalment of the dog, ECG diagnosis, echocardiographic findings, PPI technique, and programing of the pacemaker were recorded. Survival length (days) was recorded as the last veterinary visit; if the dog was dead the reason was documented. Cumulative survival of each pacemaker was examined by a Kaplan-Meier survival curve and the two techniques compared with a logrank test. Chi-square was used to determine the association between major complications and death. A total of 66 dogs with 52 transvenous and 30 epicardial PPIs were included. All epicardial pacemakers were implanted via transdiaphragmatic approach. A total of 31 life-threatening complications were reported. There were nine deaths related to major complications (13.6% of the study sample). The median follow-up period was 366 days, with a median survival of 255 days, and a significant difference in cumulative survival of each pacemaker (P = 0.01) between epicardial (93 days, range 0-1882 days) and transvenous (334 days, range 0-2745) PPIs but no significant difference in cumulative survival between the two techniques when only the first pacemaker was considered (p = 0.07). The presence of a major complications had a significant association with death due to pacemaker complications (P<0.001). The decision to perform epicardial PPI in failed transvenous PPI patients may have skewed the cumulative survival as was evident in the lack of significant difference in survival when only first PPI were examined. Major complication rates between the two techniques were similar and the authors consider both techniques equally reliable to manage symptomatic bradycardia in dogs.
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Affiliation(s)
- Liza S. Köster
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
| | - Xiaojuan Zhu
- Office of Information Technology, University of Tennessee, Knoxville, TN, United States of America
| | - Christopher K. Smith
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
| | - Josep Aisa
- Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, United States of America
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Sanz-Gonzalez I, Aitken J, Pedro B, Martin M, Martinez Pereira Y, Dukes-McEwan J, Bode EF, Culshaw GJ. Clinical presentation, management, and survival in dogs with persistent atrial standstill in the United Kingdom. J Vet Cardiol 2023; 51:179-187. [PMID: 38150959 DOI: 10.1016/j.jvc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES To investigate the clinical and echocardiographic presentation of dogs with persistent atrial standstill (PAS), identify variables measured at first presentation that could predict their survival, and document the progression of the disease after pacing. MATERIALS AND METHODS Retrospective study of medical records of dogs diagnosed with PAS at three referral hospitals of the United Kingdom over seven years. RESULTS Twenty-six dogs were diagnosed with PAS during the study period. Median age of the population was three years (range: 7 months-12.5 years). The most common clinical sign was syncope (14/26). Twenty-four dogs received artificial pacemakers (PM). Major complications after PM implantation were observed in four dogs (4/24). Serial echocardiographic examinations showed that cardiac dimensions of PAS dogs with left atrial or left ventricular dilation at first presentation did not return to reference range after pacing. Further dilation of the cardiac chambers, recurrence of congestive heart failure (CHF), or development of new episodes of CHF were documented in 7, 4, and 10 PAS dogs, respectively, despite pacing. Median survival time for cardiac-related deaths after PM implantation was 1512 days (18-3207). Neither CHF nor echocardiographic variables at presentation predicted survival after PM implantation in PAS dogs. CONCLUSIONS PAS is an uncommon bradyarrhythmia, occurring in young adult dogs. Affected dogs were often presented with syncope. Whilst syncope resolved, cardiac remodeling persisted after PM implantation. Long-term survival was favorable after PM implantation and was not predicted by congestive status or cardiac chamber size at first presentation.
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Affiliation(s)
- I Sanz-Gonzalez
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom.
| | - J Aitken
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Building 400, Parkville, Victoria, 3052, Australia
| | - B Pedro
- Centro de Cardiologia Veterinaria do Porto, Rua Artur Maia Mendes 93, 4250-068, Porto, Portugal
| | - M Martin
- Veterinary Cardiology Consultancy, Kenilworth, CV8 2AA, United Kingdom
| | - Y Martinez Pereira
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom
| | - J Dukes-McEwan
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, United Kingdom; ChesterGates Veterinary Specialists, Telford Court, Gates Lane, Chester, Cheshire, CH1 6LT, United Kingdom
| | - G J Culshaw
- Hospital for Small Animals, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Edinburgh, United Kingdom
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Gómez-Torres F, Ballesteros-Acuña L, Ruíz-Sauri A. Histopathological changes in the electrical conduction of cardiac nodes after acute myocardial infarction in dogs and horses, compared with findings in humans: A histological, morphometrical, and immunohistochemical study. Vet World 2023; 16:2173-2185. [PMID: 38023272 PMCID: PMC10668561 DOI: 10.14202/vetworld.2023.2173-2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Aim The heart conduction system is responsible for the occurrence of various types of cardiac arrhythmia. This study aimed to histologically and morphometrically describe damaged cardiac nodes during acute myocardial infarction and to compare them with normal tissues in dogs and horses. Materials and Methods This study describes the morphometry of cardiac nodes in five dogs and five elderly horses that succumbed to sudden cardiac death (SCD). A computerized morphometric study was conducted to determine the number of cells composing the nodes, different shape and size parameters of nodes, and their relationship with degenerative changes due to cardiac conditions. Results In both species, the sinoatrial node (SAN) was ovoid in shape whereas the atrioventricular node (AVN) was pyramidal in shape. The percentage of collagen fibers inside the SAN of dogs (47%) and horses (50%) was found to be higher than that of cells. In contrast, the percentage of cells in the AVN of dogs (24%) and horses (16%) was higher than that of connective tissues. In the SAN, the area (p = 0.09), maximum diameter (<0.001), and mean diameter (0.003) of P cells were larger in dogs than in horses. Conclusion Overall, the SAN cells and surrounding cardiomyocytes in dogs and horses as well as the AVN cells in dogs that succumbed to SCD decreased in size compared with those in normal hearts.
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Affiliation(s)
- Fabián Gómez-Torres
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Luis Ballesteros-Acuña
- Department of Basic Sciences, School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Amparo Ruíz-Sauri
- Department of Pathology, Faculty of Medicine, Universitat de Valencia, Valencia, Spain
- INCLIVA Biomedical Research Institute, Valencia, Spain
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McGrath C, Dixon A, Hirst C, Bode EF, DeFrancesco T, Fries R, Gordon S, Hogan D, Martinez Pereira Y, Mederska E, Ostenkamp S, Sykes KT, Vitt J, Wesselowski S, Payne JR. Pacemaker-lead-associated thrombosis in dogs: a multicenter retrospective study. J Vet Cardiol 2023; 49:9-28. [PMID: 37541127 DOI: 10.1016/j.jvc.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/18/2023] [Accepted: 06/25/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Pacemaker implantation is the treatment of choice for clinically relevant bradyarrhythmias. Pacemaker-lead-associated thrombosis (PLAT) occurs in 23.0-45.0% of people with permanent transvenous pacemakers. Serious thromboembolic complications are reported in 0.6-3.5%. The incidence of PLAT in dogs is unknown. ANIMALS, MATERIALS AND METHODS multicenter retrospective study of seven centers with 606 client-owned dogs undergoing permanent pacemaker implantation between 2012 and 2019. 260 dogs with a transvenous pacemaker with echocardiographic follow-up, 268 dogs with a transvenous pacemaker without echocardiographic follow-up and 78 dogs with an epicardial pacemaker. RESULTS 10.4% (27/260) of dogs with transvenous pacemakers and echocardiographic follow-up had PLAT identified. The median time to diagnosis was 175 days (6-1853 days). Pacemaker-lead-associated thrombosis was an incidental finding in 15/27 (55.6%) dogs. Of dogs with a urine protein:creatinine ratio measured at pacemaker implantation, dogs with PLAT were more likely to have proteinuria at pacemaker implantation vs. dogs without PLAT (6/6 (100.0%) vs. 21/52 (40.4%), P=0.007). Urine protein:creatinine ratio was measured in 12/27 (44.4%) dogs at PLAT diagnosis, with proteinuria identified in 10/12 (83.3%) dogs. Anti-thrombotic drugs were used following the identification of PLAT in 22/27 (81.5%) dogs. The thrombus resolved in 9/15 (60.0%) dogs in which follow-up echocardiography was performed. Dogs with PLAT had shorter survival times from implantation compared to those without PLAT (677 days [9-1988 days] vs. 1105 days [1-2661 days], P=0.003). CONCLUSIONS Pacemaker-lead-associated thrombosis is identified in 10.4% (27/260) of dogs following transvenous pacing, is associated with proteinuria, can cause significant morbidity, and is associated with reduced survival times.
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Affiliation(s)
- C McGrath
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - A Dixon
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - C Hirst
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - T DeFrancesco
- College of Veterinary Medicine, North Carolina State Veterinary Hospital, 1052 William Moore Dr., Raleigh, NC, 27607, USA
| | - R Fries
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Gordon
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - D Hogan
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - Y Martinez Pereira
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, United Kingdom
| | - E Mederska
- Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral, CH64 7TE, United Kingdom
| | - S Ostenkamp
- Purdue University Small Animal Hospital, West Lafayette, Indiana LYNN, 625 Harrison St., West Lafayette, IN, 47907, USA
| | - K T Sykes
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J Vitt
- University of Illinois Veterinary Teaching Hospital, 1008 W Hazelwood Dr., Urbana, IL, 61802, USA
| | - S Wesselowski
- Texas A&M University Veterinary Medical Teaching Hospital, 408 Raymond Stotzer Pkwy, College Station, TX, 77845, USA
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, Langford, Bristol, BS40 5DU, United Kingdom.
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Successful Clindamycin Therapy of an Infected Subcutaneous Permanent Pacing Lead in a Dog after a Failed Course with Potentiated Amoxicillin and Enrofloxacin. Vet Sci 2023; 10:vetsci10020093. [PMID: 36851397 PMCID: PMC9964686 DOI: 10.3390/vetsci10020093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Though permanent pacemaker implantation is the only effective therapy for certain bradyarrhythmias in dogs, it is not without risks. Bacterial infection of the device is one of the most common complications. Human guidelines recommend besides systemic antibiotics, surgical explantation of the pacing lead and pulse generator in case of device-infection. This report describes a 13.5-year-old dog that received a transvenous endocardial permanent pacemaker because of syncopal episodes resulting from paroxysmal third-degree atrio-ventricular block. Five days after an uneventful surgery, a painful swelling appeared around the subcutaneous part of the lead where this was inserted into the jugular vein. A 4-week course of amoxicillin and clavulanic acid combined with enrofloxacin failed to clear the infection on long-term. Ultrasound-guided puncture of the abscess was performed to gain a sample for bacterial culture and antibiogram. Oral clindamycin of 4 weeks' duration successfully resolved the infection with Staphylococcus aureus without having to explant the device. Repeated ultrasonographic examinations and fine-needle aspiration biopsies were used to evaluate for persistent local inflammation, guiding the length of the antibiotic therapy. Though the described approach has traditionally been ill-advised because of the risk of introducing bacteria and damaging the pacemaker lead, it was successful in our case.
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Pires A, Raheb S, Monteith G, Colpitts ME, Chong A, O'Sullivan ML, Fonfara S. Heart rate distribution in dogs with third degree atrioventricular block and rate responsive pacemakers. J Vet Cardiol 2022; 43:70-80. [PMID: 36044810 DOI: 10.1016/j.jvc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In dogs, single lead ventricular pacing, ventricular sensing, inhibition response, rate adaptive (VVIR) pacemakers are routinely used to treat third degree atrioventricular block. The objectives of this study were to investigate the heart rate distribution in dogs with VVIR pacemakers, and report changes when activity settings were adjusted. ANIMALS Eighteen client-owned dogs with VVIR pacemakers for third degree atrioventricular block. MATERIALS AND METHODS This observational study consisted of a review of medical records of dogs with VVIR pacemakers. For dogs with >50% of paced beats at the lower pacing rate, the activity daily living (ADL) and exertion responses were increased. Re-evaluations were performed after 6-12 months. RESULTS Heart rate distribution similar to healthy dogs was absent for all dogs. In nine dogs, the ADL and exertion responses were increased to the highest level. Of these, three dogs showed no improvement in heart rate distribution; for two dogs, one with an epicardial pacemaker, several activity settings were adjusted and pacing at higher heart rates was observed at re-evaluation. Four dogs died or were lost to follow-up. Clinical signs had resolved for all dogs after pacemaker implantation. CONCLUSION Default activity settings of VVIR pacemakers do not result in heart rate distribution equivalent to healthy dogs. Increasing the ADL and exertion response settings to the highest levels did not improve the pacemaker rate response. Further investigations into the role of dog size, generator positioning, pacemaker settings, and whether rate responsiveness is required for dogs' quality and quantity of life are warranted.
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Affiliation(s)
- A Pires
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - S Raheb
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - G Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - M E Colpitts
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - A Chong
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - M L O'Sullivan
- Department of Companion Animals, Atlantic Veterinary College, University of Prince Edward Island, 550 University Ave, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - S Fonfara
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
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Forsyth KK, Arsenault WG. ECG of the Month. J Am Vet Med Assoc 2022; 260:1-3. [PMID: 35594201 DOI: 10.2460/javma.21.07.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kiersten K Forsyth
- 1Southwest Florida Veterinary Specialists, Bonita Springs, FL.,2Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
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deLaforcade A, Bacek L, Blais M, Boyd C, Brainard BM, Chan DL, Cortellini S, Goggs R, Hoareau GL, Koenigshof A, Li R, Lynch A, Ralph A, Rozanski E, Sharp CR. 2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk. J Vet Emerg Crit Care (San Antonio) 2022; 32:289-314. [PMID: 35499966 PMCID: PMC9322658 DOI: 10.1111/vec.13204] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations. DESIGN A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats). RESULTS Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism. CONCLUSIONS Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.
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Affiliation(s)
- Armelle deLaforcade
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Lenore Bacek
- Bluepearl Specialty and Emergency Pet HospitalTampaFloridaUSA
| | - Marie‐Claude Blais
- Department of Clinical SciencesUniversity of MontrealSaint‐HyacintheQCCanada
| | - Corrin Boyd
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, Clinical SciencesUniversity of GeorgiaAthensGeorgiaUSA
| | - Daniel L. Chan
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Stefano Cortellini
- Department of Clinical Science and ServicesThe Royal Veterinary CollegeLondonUK
| | - Robert Goggs
- Department of Clinical SciencesCornell University College of Veterinary MedicineIthacaNew YorkUSA
| | | | - Amy Koenigshof
- Department of Emergency CareTwo by Two Animal HospitalBerrien SpringsMichiganUSA
| | - Ron Li
- Department of Veterinary Surgical and Radiological SciencesSchool of Veterinary MedicineUniversity of California DavisDavisCaliforniaUSA
| | - Alex Lynch
- Department of Clinical SciencesNC State College of Veterinary MedicineRaleighNorth CarolinaUSA
| | | | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary MedicineTufts UniversityNorth GraftonMassachusettsUSA
| | - Claire R Sharp
- School of Veterinary MedicineMurdoch UniversityMurdochAustralia
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Alvarez-Sanchez A, Townsend KL, LeBlanc NL, Milovancev M, Scollan KF, Heatley J, Hoppes S, Saunders AB, Gordon SG, Pesce K, Swift ST, Brenner E, Thomason JD, Eshar D. Epicardial pacemaker implantation and outcome in eight pet ferrets (Mustela putorius furo). J Vet Cardiol 2022; 41:44-56. [DOI: 10.1016/j.jvc.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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de Carellán Mateo AG, Casamián-Sorrosal D. The perioperative management of small animals with previously implanted pacemakers undergoing anaesthesia. Vet Anaesth Analg 2021; 49:7-17. [PMID: 34916163 DOI: 10.1016/j.vaa.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/26/2020] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is little information in the veterinary literature about the perioperative management of small animal patients with previously implanted pacemakers undergoing elective or emergency non-cardiac procedures. The purpose of this article is to review the current literature with regard to human patients, with previously implanted pacemakers, undergoing general anaesthesia. Using this and the current information on pacemakers and anaesthesia in dogs and cats, we provide recommendations for small animal patients in this situation. DATABASES USED Google Scholar, PubMed and CAB Abstracts using and interlinking and narrowing the search terms: "dog", "cat", "small animals", "anaesthesia", "pacemaker", "perioperative", "transvenous pacing", "temporary pacing". Scientific reports and human and small animal studies from the reference lists of the retrieved papers were reviewed. In addition, related human and veterinary cardiology and anaesthesia textbooks were also included to create a narrative review of the subject. CONCLUSIONS The best perioperative care for these animals comes from a multidisciplinary approach involving the anaesthetist, cardiologist, surgeon and intensive care unit team. When such an approach is not feasible, the anaesthetist should be familiar with pacemaker technology and how to avoid perioperative complications such as electromagnetic interference, lead damage and reprogramming of the device. The preanaesthetic assessment should be thorough. Information regarding the indication for pacemaker placement, complications during the procedure, location, type and programming of the pacemaker should be readily available. The anaesthetic management of these veterinary patients aims to preserve cardiovascular function while avoiding hypotension, and backup pacing should be available during the perioperative period. Further prospective studies are needed to describe the best perioperative care in small animals with a previously implanted pacemaker.
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Affiliation(s)
- Alejandra García de Carellán Mateo
- Anaesthesia and Analgesia Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain.
| | - Domingo Casamián-Sorrosal
- Cardiology and Interventional Cardiology Service, Teaching Veterinary Hospital, Department of Animal Medicine and Surgery, School of Veterinary Science, Catholic University of Valencia, Valencia, Spain
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15
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Porciello F, Marchesi MC, Birettoni F, Spina F, Knafelz P, Bufalari A, Rishniw M, Moise NS, Caivano D. Transthoracic echo-guided pacemaker implantation reduces fluoroscopic use in dogs. Vet J 2021; 277:105762. [PMID: 34655788 DOI: 10.1016/j.tvjl.2021.105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
Echocardiographic guidance provides an alternative method when fluoroscopy is unavailable, equipment or power failure of fluoroscopic equipment during a procedure occurs or to decrease radiation risk. Recently, transthoracic (TTE) and transesophageal echocardiography were reported as an alternative method to guide interventional procedures in dogs. Therefore, we hypothesized that TTE could be used as an alternative method to visualize endocardial leads during pacemaker implantation in dogs, largely avoiding the use of fluoroscopy. A prospective consecutive case series of pacemaker implantation was performed using TTE guidance. The endocardial lead was imaged by TTE during its intracardiac advancement until the lead tip was positioned at the right ventricular apex. Echocardiographic right parasternal views, optimized to visualize the pacing lead, were used, starting with a short axis image of the right atrium and ending with a long axis view of the right ventricle (RV) optimized to image the RV apex. Proper lead placement was confirmed by both capture threshold, impedance and fluoroscopy. Twenty-one pacemaker implantation procedures by TTE monitoring were successfully performed. The TTE guidance provided images of a quality sufficient to clearly monitor implantation in real-time and allowed for immediate corrections to pacing lead malpositioning or excessive looping. Fluoroscopy was used to confirm the correct placement of the lead that was guided echocardiographically in the initial three procedures, after which a single radiographic image (no cine-mode) was used to identify lead placement and redundancy in the remaining eighteen cases. Static imaging (radiography using the fluoroscope) was used to assess the proper lead redundancy in all procedures because this cannot be evaluated echocardiographically. Pacemaker leads were successfully implanted in the RV of dogs using TTE monitoring. A larger cases series is needed for validation of safety and effectiveness of TTE during this interventional procedure in dogs.
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Affiliation(s)
- F Porciello
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy.
| | - M C Marchesi
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Birettoni
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - F Spina
- Veterinary Hospital 'Etiopia', Viale Etiopia 16, Rome, 00199 Italy
| | - P Knafelz
- Veterinary Hospital 'GregorioVII', Piazza di Villa Carpegna 52, Rome, 00165 Italy
| | - A Bufalari
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
| | - M Rishniw
- Veterinary Information Network, Davis, CA 95616, USA; Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - N S Moise
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - D Caivano
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, Perugia, 06126 Italy
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16
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Frantz EW, Tjostheim SS, Palumbo A, Kellihan HB, Stepien RL. A retrospective evaluation of the indications, complications, and outcomes associated with epicardial pacemakers in 20 cats from a single institution. J Vet Cardiol 2021; 36:89-98. [PMID: 34118563 DOI: 10.1016/j.jvc.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The objective of this retrospective study was to describe the indications, complications, and long-term outcomes in a group of cats that received an epicardial pacing (EP) system. ANIMALS Twenty client-owned cats. MATERIALS AND METHODS Medical records were reviewed for signalment, presenting complaint, primary electrocardiogram (ECG) diagnosis, presence of structural heart disease, presence of congestive heart failure (CHF), presence of major or minor complications, and survival time. RESULTS The majority of cats were presented for syncope (n = 11), and the most common ECG diagnosis was advanced second-degree atrioventricular block (n = 9). Fifteen cats (15/20, 75%) had one or more major or minor complications. One cat died in the perioperative period as a result of a major complication. None of the variables evaluated were associated with a statistically significant increase in the occurrence of major or minor complications. The most common major complication was loss of ventricular capture (seven instances in six cats), which was successfully treated in all cases by increasing pacemaker output or replacing both the lead and the pulse generator. The most common minor complications were arrhythmias (n = 7) and sensing issues (n = 8). The overall median survival time (MST) was 948 days. No statistical difference in survival time was identified between cats that experienced a major complication and those that did not. CONCLUSIONS Although complications were common in this feline population after EP, major and minor complications were successfully treated.
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Affiliation(s)
- E W Frantz
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - S S Tjostheim
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA.
| | - A Palumbo
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - H B Kellihan
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
| | - R L Stepien
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr. Madison, WI 53706, USA
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Raleigh JS, Culp WTN, Brady R, Al-Nadaf S, Kent MS, Kaplan JL, Stern JA, Visser LC, Niedringhaus KD, Wolf TG, Choi E, Affolter VK. Biopsy of an intracardiac paraganglioma in a dog using a fluoroscopically guided endovascular technique. J Vet Intern Med 2021; 35:1536-1541. [PMID: 33955047 PMCID: PMC8162608 DOI: 10.1111/jvim.16118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/12/2022] Open
Abstract
A 10‐year‐old female spayed mixed breed dog was evaluated for diarrhea and vomiting. Diagnostic imaging demonstrated the presence of an intracardiac mass. A modified Seldinger technique was used to access the right jugular vein, and an endomyocardial biopsy forceps was introduced through a sheath to obtain several biopsies. Histopathology and immunohistochemistry demonstrated a paraganglioma. The dog underwent 1 fraction of radiotherapy and l‐asparaginase chemotherapy and was discharged. The dog developed a pulmonary thromboembolism 2 days after radiotherapy and chemotherapy, and the owner elected humane euthanasia. Although long‐term assessment of treatment response was unable to be performed, this novel diagnostic option could be considered for similar cases due to success in obtaining a histopathologic diagnosis, which is essential in developing a disease‐specific treatment plan. This report also describes the use of radiotherapy for primary treatment of an intracardiac neoplasm, which can be a consideration in the future.
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Affiliation(s)
- Joseph S Raleigh
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - Rachel Brady
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - Sami Al-Nadaf
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - Michael S Kent
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - Joanna L Kaplan
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - Joshua A Stern
- Department of Medicine and Epidemiology, University of California-Davis, Davis, California, USA
| | - Lance C Visser
- Department of Medicine and Epidemiology, University of California-Davis, Davis, California, USA
| | - Kevin D Niedringhaus
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - Tatiana G Wolf
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California, USA
| | - Eunju Choi
- Department of Pathology, Microbiology, and Immunology, University of California-Davis, Davis, California, USA
| | - Verena K Affolter
- Department of Pathology, Microbiology, and Immunology, University of California-Davis, Davis, California, USA
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18
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Sasaki T, Saeki C, Hirakawa A, Machida N. Pathological Features of Complete Atrioventricular Block in Dogs with Lymphocytic Myocarditis. J Comp Pathol 2019; 174:18-25. [PMID: 31955799 DOI: 10.1016/j.jcpa.2019.10.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/20/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
The cardiac conduction system was examined histologically in 12 canine cases of lymphocytic myocarditis with complete atrioventricular (AV) block. Histological analysis showed active myocarditis characterized by intense infiltration of mononuclear cells, primarily lymphoid, associated with degeneration and necrosis of the adjacent cardiomyocytes. Additionally, there was healing or healed myocarditis manifested by disappearance of cardiomyocytes and replacement fibrosis. This destructive inflammatory process of lymphocytic myocarditis involved the whole of the AV conduction system, resulting in loss and deletion of the conduction fibres, as well as the myocardium of all chambers. Such total or subtotal destruction of the AV conduction system caused by the inflammatory changes was thought to have set the stage for blocking AV conduction of cardiac impulses, but the aetiology of the lymphocytic myocarditis was not elucidated.
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Affiliation(s)
- T Sasaki
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo
| | - C Saeki
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo
| | - A Hirakawa
- Pet Clinic Hallelujah, 2544-1 Nakabaru, Kasuya, Kasuya-gun, Fukuoka, Japan
| | - N Machida
- Laboratory of Veterinary Clinical Oncology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo.
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Abstract
Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.
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Affiliation(s)
- Minh Huynh
- Centre Hospitalier Vétérinaire Frégis, 43 Avenue Aristide Briand, Arcueil 94110, France.
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20
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Ward J, McLaughlin A, Burzette R, Keene B. The effect of a surgical safety checklist on complication rates associated with permanent transvenous pacemaker implantation in dogs. J Vet Cardiol 2019; 22:72-83. [DOI: 10.1016/j.jvc.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/09/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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21
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Epicardial pacemaker implantation in small animals. J Vet Cardiol 2019; 22:65-71. [DOI: 10.1016/j.jvc.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 11/22/2022]
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Retrospective Analysis of Indications and Complications Related to Implantation of Permanent Pacemaker: 25 Years of Experience in 31 Dogs. J Vet Res 2019; 63:133-140. [PMID: 30989145 PMCID: PMC6458549 DOI: 10.2478/jvetres-2019-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Pacemaker implantation is the only effective symptomatic treatment for life-threatening bradyarrhythmias. Major complications observed after implantation of cardiac pacemakers include lead dislocation, loss of pulse generator function, and inadequate stimulation. The aim of this retrospective single-centre study was to analyse the indications for pacemaker implantation and the incidence and types of complications associated with this procedure in dogs treated for symptomatic bradyarrhythmia. Material and Methods The retrospective analysis included 31 dogs with symptomatic bradyarrhythmia, implanted with permanent cardiac pacemakers in 1992-2017. The list of analysed variables included patient age, breed, sex, indication for pacemaker implantation, comorbidities, and the incidence of procedure-related complications along with the type thereof. Results The most common indication for pacemaker implantation was 3rd degree AVB, followed by SSS, advanced 2nd degree AVB, and PAS. Pacemaker implantation was associated with a 35% overall complication rate and 6.45% periprocedural mortality. There were no significant differences in terms of procedure-related complications with regard to age, sex, breed, indications for pacemaker implantation, or comorbidities. Conclusions Cardiac pacing is the only effective treatment of symptomatic bradycardia, but as an invasive procedure, may pose a risk of various complications, including death.
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LeBlanc NL, Agarwal D, Menzen E, Nomi K, Sisson DD, Scollan KF. Prevalence of major complications and procedural mortality in 336 dogs undergoing interventional cardiology procedures in a single academic center. J Vet Cardiol 2019; 23:45-57. [PMID: 31174729 DOI: 10.1016/j.jvc.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Overall complication rates associated with a wide range of diagnostic and therapeutic interventional cardiac procedures in a contemporary academic setting have not been reported. ANIMALS, MATERIALS AND METHODS Consecutive interventional procedures performed for client-owned dogs were retrospectively analyzed to characterize procedural complications and mortality. RESULTS Three hundred sixty-four procedures were performed on 336 dogs. Interventions included attempted or completed transvenous pacemaker (PM) implantation (n = 134) with subsequent pacing system revision (n = 8), pulmonic balloon valvuloplasty (BVP) (n = 117) with a subset of patients undergoing an additional BVP (n = 14), transarterial closure of left-to-right shunting patent ductus arteriosus (PDA) (n = 66), diagnostic angiography and/or cardiovascular pressure measurement (n = 9), transvenous temporary pacing (n = 7), septal defect occlusion (n = 5), heartworm extraction (n = 3), and BVP catheter fragment retrieval (n = 1). The prevalence of major perioperative and postoperative complications for all procedures was 5% and 6%, respectively, and the procedural mortality rate was 2%. The overall rate of major complications was 12% for the PM group, 11% for the BVP group, and 2% for the PDA occlusion group. Both PM implantation and BVP have higher rates of major complications overall compared with PDA occlusion (p=0.0151). CONCLUSIONS The results of this study indicate that the prevalence of major complications and mortality associated with interventional cardiac procedures is low; however, significant differences exist in complication rates between procedures.
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Affiliation(s)
- N L LeBlanc
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA.
| | - D Agarwal
- MedVet Medical and Cancer Center for Pets, Cardiology Department, 3964 Red Bank Road, Cincinnati, Ohio 45227, USA
| | - E Menzen
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K Nomi
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - D D Sisson
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K F Scollan
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
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24
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Indications for permanent pacing in dogs and cats. J Vet Cardiol 2019; 22:20-39. [PMID: 30709617 PMCID: PMC7185536 DOI: 10.1016/j.jvc.2018.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022]
Abstract
Pacemaker implantation is considered as a standard procedure for treatment of symptomatic bradycardia in both dogs and cats. Advanced second-degree and third-degree atrioventricular blocks, sick sinus syndrome, persistent atrial standstill, and vasovagal syncope are the most common rhythm disturbances that require pacing to either alleviate clinical signs or prolong survival. Most pacemakers are implanted transvenously, using endocardial leads, but rarely epicardial leads may be necessary. To decide whether a patient is a candidate for pacing, as well as which pacing modality should be used, the clinician must have a clear understanding of the etiology, the pathophysiology, and the natural history of the most common bradyarrhythmias, as well as what result can be achieved by pacing patients with different rhythm disturbances. The goal of this review was, therefore, to describe the indications for pacing by evaluating the available evidence in both human and veterinary medicine. We described the etiology of bradyarrhythmias, clinical signs and electrocardiographic abnormalities, and the choice of pacing modality, taking into account how different choices may have different physiological consequences to selected patients. It is expected that this review will assist veterinarians in recognizing arrhythmias that may require permanent pacing and the risk-benefit of each pacing modality and its impact on outcome.
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25
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Transvenous pacing implantation: techniques, tips, and lessons learned along the way. J Vet Cardiol 2019; 22:51-64. [PMID: 30661842 DOI: 10.1016/j.jvc.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/21/2018] [Accepted: 08/15/2018] [Indexed: 11/23/2022]
Abstract
The right ventricular apex has been the traditional site for lead placement in veterinary patients who require permanent cardiac pacing therapy for atrioventricular block and sick sinus syndrome. Implantation of leads in this location is a straightforward procedure that most veterinary cardiologists perform routinely. Pacing at the right ventricular apex, however, has been demonstrated to have long-term deleterious effects on the left ventricular function in numerous patient populations and animal models. Alternative lead placement sites and pacing system configurations have been developed, and the purpose of this review article is not to review the literature or the decision-making process in selecting a specific pacing system but rather to share the experiences of our group with the use of alternative pacing implantation techniques for veterinary patients in need of permanent cardiac pacing.
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Identification and management of a subacute right ventricular perforation by an active-fixation permanent pacemaker lead in a dog. J Vet Cardiol 2018; 22:113-120. [PMID: 30581086 DOI: 10.1016/j.jvc.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022]
Abstract
A 5-year-old short-haired dachshund was referred with a history of repeated syncope associated with a third-degree atrioventricular block. A permanent transvenous pacemaker with an active-fixation lead was implanted. In the following 3 weeks, the syncopal episodes reappeared owing to a loss of ventricular capture. The pacemaker was reprogrammed to higher output, and effective pacing was re-established. Thoracic radiographs and echocardiography failed to identify any evidence of lead displacement. One month later, the patient presented a new episode of loss of capture. After fluoroscopy, cardiac perforation was suspected and subsequently confirmed by thoracotomy. An epicardial pacemaker lead was implanted without removing the perforating lead as there were no bleeding complications or damage to adjacent organs, and the length of time elapsed since implantation was assumed to have allowed for significant fibrotic adhesions to develop. Nineteen months after epicardial pacemaker implantation, endocardial lead dislodgement occurred. Simultaneously, the dog presented with gastrointestinal and respiratory abnormalities and severe thrombocytopenia. Once the dog was stabilized, the endocardial lead was percutaneously removed. One month later, loss of ventricular capture recurred. The owners declined any further treatment, and euthanasia was elected. Cardiac perforation after pacemaker implantation is an infrequent complication. In this case, the dog lived 22 months after subacute right ventricular perforation. Despite the poor prognosis associated with cardiac perforation by pacemaker leads, different approaches are possible to successfully manage this major complication. Extraction of the displaced lead remains controversial as, if the lead is not removed, late lead migration can occur.
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27
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Karlin ET, Rush JE, Nobrega EA. Synchronous diaphragmatic contraction associated with dual-chamber transvenous pacing in a dog. J Vet Cardiol 2018; 22:106-112. [PMID: 30503648 DOI: 10.1016/j.jvc.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022]
Abstract
A 3-year-old, 20-kg, spayed female, mix-breed dog received a dual-chamber pacemaker for management of symptomatic 3rd-degree atrioventricular block. Synchronous diaphragmatic contraction was documented to occur with atrial pacing. Various methods to reduce the occurrence of pacemaker-related phrenic nerve stimulation are discussed.
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Affiliation(s)
- E T Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Rd, North Grafton, MA 01536, USA
| | - J E Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westboro Rd, North Grafton, MA 01536, USA.
| | - E A Nobrega
- Boston Scientific Corporation, 3 Scimed Place, Maple Grove, MN 55311, USA
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Swanson LE, Huibregtse BA, Scansen BA. A retrospective review of 146 active and passive fixation bradycardia lead implantations in 74 dogs undergoing pacemaker implantation in a research setting of short term duration. BMC Vet Res 2018; 14:112. [PMID: 29580281 PMCID: PMC5870196 DOI: 10.1186/s12917-018-1431-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 03/15/2018] [Indexed: 11/17/2022] Open
Abstract
Abstract Background Canine veterinary patients increasingly benefit from implantation of transvenous pacemakers for bradyarrhythmias. No published data exist examining procedural outcomes of pacemaker implantation performed in the preclinical laboratory. The purpose was to review short term complication, infection, dislodgement, penetration rates, plus overall morbidity following pacemaker implantation in the research setting. A retrospective review of 74 Class A purpose-bred mongrels implanted with active (n = 89) and passive fixation (n = 57) intracardiac leads for dual (n = 72) or single (n = 2) chamber pacing was performed. Results All leads were implanted successfully, meeting electrical implant criteria. Follow-ups typically occurred every 7 days (first month), then at 30 day intervals. Seroma formation was 1.4% and 10.8% at the venotomy and pulse generator site respectively. Overall infection rate was 1.4%. Overall dislodgement rate was 2.1%, (2 passive atrial leads, 1 passive ventricular lead). Overall fractures and insulation defects were zero. Two helix penetrations were noted incidentally post mortem, one at the right atrial appendage and one at the right ventricle (64 dogs, 128 leads evaluated), a 1.6% event rate. Major in-life adverse events were 5.4% (4 of 74 dogs), including 1 infection and 3 lead dislodgements. Conclusions This review demonstrates a low complication rate with bradycardia lead implants in the short term (up to 180 days), in a high volume research setting. Lead type, implant technique, surgeon experience, healthy patient population, patient size and follow-up care play a role. This review also suggests active fixation leads in the right atrial appendage of dogs are safe and reliable. Electronic supplementary material The online version of this article (10.1186/s12917-018-1431-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lynne E Swanson
- Research and Technology Center, Boston Scientific Corporation, 4100 Hamline Ave North, Saint Paul, MN, 55112, USA.
| | - Barbara A Huibregtse
- Preclinical Sciences, Boston Scientific Corporation, 100 Boston Scientific Way, Marlborough, MA, 01752, USA
| | - Brian A Scansen
- Department of Clinical Sciences, Colorado State University, 1678 Campus Delivery, Fort Collins, CO, 80523-1678, USA
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Abstract
Sick sinus syndrome (SSS) is a type of bradyarrhythmia that can lead to syncope. Cilostazol has been reported to be an effective treatment for human patients with SSS and other bradyarrhythmias. This report describes the successful long-term treatment with cilostazol in a dog with SSS. A nine-year old intact male Miniature Schnauzer presented with a history of syncopal episodes and unsteady gait. After cilostazol treatment, the total heart rate (HR), mean HR, and frequency of premature ventricular contractions (PVCs) increased, while the maximum HR and maximum pause time decreased. Additionally, the number of syncopal episodes decreased. The dog died suddenly, 1,418 days after the start of cilostazol treatment. Cilostazol may be a useful therapeutic agent in canines with SSS.
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Affiliation(s)
- Nobuyuki Kanno
- Division of Veterinary Cardiovascular Medicine and Surgery, Laboratory of Veterinary Medical Therapeutics, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa-shi, Kanagawa 252-0880, Japan
| | - Tomohiro Suzuki
- Ikime Animal Hospital, 3036-4 Ukita, Ooaza, Miyazakishi, Miyazaki 880-2104, Japan
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Cervenec R, Stauthammer C, Fine D, Kellihan H, Scansen B. Survival time with pacemaker implantation for dogs diagnosed with persistent atrial standstill. J Vet Cardiol 2017; 19:240-246. [DOI: 10.1016/j.jvc.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
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Morales JL, Nava S, Márquez MF, González J, Gómez-Flores J, Colín L, Martínez-Ríos MA, Iturralde P. Idiopathic Lead Migration: Concept and Variants of an Uncommon Cause of Cardiac Implantable Electronic Device Dysfunction. JACC Clin Electrophysiol 2017; 3:1321-1329. [PMID: 29759631 DOI: 10.1016/j.jacep.2017.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 02/15/2017] [Accepted: 02/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This cumulative case study was performed to properly address the possible mechanisms, forms, and consequences of "twiddler's," "reel," and "ratchet" syndromes. BACKGROUND Twiddler's, reel, and ratchet syndromes are rare entities responsible for lead displacement of cardiac implantable electronic devices (CIED). METHODS From 2007 to 2012, 1,472 CIED were implanted at our center. Eighty-nine cases were reviewed for failure of pacing circuit integrity. Only 9 met the inclusion criteria for idiopathic lead migration (ILM) and were grouped as ILM (twiddler) or ILM (reel). For a pooled analysis of cases, a review of the literature from 1990 to 2012 was performed, and the authors identified 78 cases from 64 publications. RESULTS The study population consisted of 87 cases (45 women; median age, 66 years; 46 with ILM [twiddler] and 41 with ILM [reel]). Migration affected only 1 lead in 65% of 46 devices with more than 1 lead. None of the previously reported risk factors-manual manipulation of the device, elderly age, obesity, oversized pocket, and psychiatric history-correlated with the risk of ILM. CONCLUSIONS Neither manual manipulation of the device nor the other traditional risk factors reported in the literature for ILM syndrome correlated with the risk of ILM.
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Affiliation(s)
- José L Morales
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Santiago Nava
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico.
| | - Manlio F Márquez
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Jorge González
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Jorge Gómez-Flores
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Luis Colín
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Marco A Martínez-Ríos
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
| | - Pedro Iturralde
- Department of Electrocardiology, National Institute of Cardiology "Ignacio Chavez," Mexico City, Mexico
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Djani D, Coleman A, Rapoport G, Schmiedt C, Layher J, Thomason J. Congestive heart failure caused by transvenous pacemaker lead prolapse and associated right ventricular outflow tract obstruction in a dog. J Vet Cardiol 2016; 18:391-397. [DOI: 10.1016/j.jvc.2016.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/04/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
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Ciavarella A, Nimmo J, Hambrook L. Pacemaker lead perforation of the right ventricle associated with Moraxella phenylpyruvica infection in a dog. Aust Vet J 2016; 94:101-6. [PMID: 27021890 DOI: 10.1111/avj.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 06/26/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022]
Abstract
CASE DESCRIPTION A 13-year-old neutered male Border Collie was presented with acute onset syncope, weakness and anorexia 10 months after transvenous pacemaker implantation. The patient was laterally recumbent, bradycardic (36 beats/min) and febrile (40.7°C) on presentation. An electrocardiogram (ECG) revealed recurrence of third-degree atrioventricular block with a ventricular escape rhythm. Fluoroscopy identified migration of the pacemaker tip through the apex of the right ventricle. Echocardiography failed to reveal any evidence of pericardial effusion or cardiac tamponade. Full postmortem was performed after euthanasia. The pacemaker lead had perforated the apex of the right ventricle and lodged in the right pleural space. Culture of blood (taken antemortem), pericardial sac, right ventricular wall (surrounding pacemaker lead), pacemaker lead tip and pericardial fluid revealed a pure growth of Moraxella phenylpyruvica. CONCLUSION Bacteraemia associated with M. phenylpyruvica has never been reported in the dog, but sporadic cases are reported in humans. Infection could have resulted from either pre-existing myocarditis or opportunistic infection and bacteraemia post pacemaker implantation. Evaluation of the pacemaker function at regular intervals would allow early detection of poor pacemaker-to-myocardium contact, which would prompt further investigation of pacemaker lead abnormalities such as perforation.
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Affiliation(s)
- A Ciavarella
- Advanced Vetcare, Level 1, 26 Robertson Street, Kensington, Victoria, 3031, Australia.
| | - J Nimmo
- ASAP Laboratory, Mulgrave, VIC, Australia
| | - L Hambrook
- Advanced Vetcare, Level 1, 26 Robertson Street, Kensington, Victoria, 3031, Australia
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Ward J, DeFrancesco T, Tou S, Atkins C, Griffith E, Keene B. Outcome and survival in canine sick sinus syndrome and sinus node dysfunction: 93 cases (2002–2014). J Vet Cardiol 2016; 18:199-212. [DOI: 10.1016/j.jvc.2016.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 03/29/2016] [Accepted: 04/08/2016] [Indexed: 12/01/2022]
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35
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Gunther-Harrington CT, Michel AO, Stern JA. Acquired tricuspid valve stenosis due to intentionally redundant transvenous lead placement for VDD pacing in two small dogs. J Vet Cardiol 2015; 17:298-303. [DOI: 10.1016/j.jvc.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/24/2015] [Accepted: 04/04/2015] [Indexed: 10/22/2022]
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Cope LA. Morphological Variations in the Canine (Canis familiaris) Right Ventricle Trabecula Septomarginalis Dextra and a Proposed Classification Scheme. Anat Histol Embryol 2015; 45:437-442. [DOI: 10.1111/ahe.12217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 10/07/2015] [Indexed: 12/01/2022]
Affiliation(s)
- L. A. Cope
- Division of Basic Medical Sciences; Mercer University School of Medicine; 1501 Mercer University Drive Macon GA 31207 USA
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37
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Ward JL, DeFrancesco TC, Tou SP, Atkins CE, Griffith EH, Keene BW. Complication rates associated with transvenous pacemaker implantation in dogs with high-grade atrioventricular block performed during versus after normal business hours. J Vet Intern Med 2015; 29:157-63. [PMID: 25619513 PMCID: PMC4858108 DOI: 10.1111/jvim.12512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/04/2014] [Accepted: 10/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background Transvenous pacemaker implantation in dogs is associated with a relatively high complication rate. At our institution, pacemaker implantation in dogs with high‐grade atrioventricular block (HG‐AVB) frequently is performed as an after‐hours emergency. Hypothesis Among dogs with HG‐AVB, the rate of major complications is higher when pacemakers are implanted after hours (AH) compared to during business hours (BH). Animals Client‐owned dogs with HG‐AVB that underwent transvenous pacemaker implantation between January 2002 and December 2012 at the North Carolina State University Veterinary Teaching Hospital. Methods Retrospective medical record review. Two‐year follow‐up was required for complications analysis. Results Major complications occurred in 14/79 dogs (18%) and included lead dislodgement, lead or generator infection, lead or generator migration, and pacing failure. Incidence of major complications was significantly higher AH (10/36, 28%) compared to BH (4/43, 9%; P = .041), and all infectious complications occurred AH. Median survival time for all dogs was 27 months and did not differ between AH and BH groups for either all‐cause (P = .70) or cardiac (P = .40) mortality. AH dogs were younger than BH dogs (P = .010), but there were no other clinically relevant differences between BH and AH groups in terms of demographic, clinical, or procedural variables. Conclusions and Clinical Importance At our institution, AH transvenous pacemaker placement is associated with a higher rate of major complications (especially infections) compared to BH placement. This difference may be because of a variety of human factor differences AH versus BH.
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Affiliation(s)
- J L Ward
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
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38
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Lichtenberger J, Scollan KF, Bulmer BJ, Sisson DD. Long-term outcome of physiologic VDD pacing versus non-physiologic VVI pacing in dogs with high-grade atrioventricular block. J Vet Cardiol 2015; 17:42-53. [DOI: 10.1016/j.jvc.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
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Sanchis-Mora S, Viscasillas J, Mathis A, Palacios C, Brodbelt DC, Alibhai HI. Anaesthetic management and complications of pacemaker implantation in dogs. Vet Rec 2014; 175:303. [PMID: 24958554 DOI: 10.1136/vr.102246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of this study was to report the anaesthetic management and peri-anaesthetic complications of 57 dogs undergoing pacemaker implantation at a referral institution over 10 years (2002-2012). The median duration of the procedure was 135 minutes (range 25-260 minutes). Patients were classified as American Society of Anaesthesiologist (ASA) III (42 cases) and ASA IV (15 cases). Forty-three patients had third-degree atrioventricular block, and 14 patients had sick sinus syndrome. The anaesthetic protocol most frequently chosen was pethidine (41 cases), etomidate-midazolam (43 cases) and isoflurane in oxygen for maintenance (57 cases). Transthoracic external pacing was used (43 cases) until the internal pacing lead was implanted. Atracurium was administered (48 cases) and intermittent positive pressure ventilation was applied in 52 cases. Complications observed included hypothermia (19 cases) and hypotension (5 cases). Three patients died (5.8%, 95% CI 1.1% to 14.6%) within the first 48 hours after termination of anaesthesia. The outcome for this procedure in sick animals appeared generally good though a number of complications were documented.
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Affiliation(s)
- S Sanchis-Mora
- Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield AL9 7TA, UK
| | - J Viscasillas
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | - A Mathis
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | - C Palacios
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
| | - D C Brodbelt
- Department of Production and Population Health, Royal Veterinary College, Hatfield, UK
| | - H I Alibhai
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, UK
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40
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Thieman Mankin KM, Dunbar MD, Toplon D, Ginn P, Maisenbacher HW, Risselada M. Rhabdomyosarcoma associated with the lead wire of a pacemaker generator implant. Vet Clin Pathol 2014; 43:276-80. [PMID: 24654997 DOI: 10.1111/vcp.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An 11-year-old female spayed Labrador Retriever was presented for a draining, painful subcutaneous mass palpated over a previously implanted pacemaker generator. Infection was suspected and the mass was removed surgically. On cut surface, the mass was friable and mottled tan to brown with firm pale tan nodules, surrounding the pacemaker lead wire adjacent to the pacemaker generator. Cytologic interpretation of impression smears was consistent with a sarcoma, and suggestive of a rhabdomyosarcoma due to the presence of strap-like cells. On histopathologic examination, a highly invasive nodular mass surrounded the pacemaker lead, composed of pleomorphic round, spindle and strap cells, and multinucleated giant cells. The population exhibited microscopic invasion into the deep portion of the fibrous capsule surrounding the pacemaker generator. There were tumor emboli within small to medium subcutaneous veins adjacent to the mass. Immunohistochemically, the neoplastic cells stained positive for α-sarcomeric actin and vimentin, and negative for α-smooth muscle actin, consistent with a rhabdomyosarcoma arising at the site of the pacemaker generator. To our knowledge, this is the first report of a rhabdomyosarcoma associated with the lead wire of a pacemaker generator in a dog.
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Affiliation(s)
- Kelley M Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
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41
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De Monte V, Staffieri F, Birettoni F, Bufalari A. Ketamine as a part of anaesthetic management in a dog with twiddler's syndrome. J Small Anim Pract 2013; 55:116-20. [PMID: 24117717 DOI: 10.1111/jsap.12139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An 11-year-old male German shepherd dog was referred for possible pacemaker implantation. A routine 6-lead electrocardiogram revealed a third-degree atrio-ventricular block with a heart rate of 40 to 45 beats/minute. A transvenous pacemaker implantation procedure was scheduled. The dog was premedicated with 10 µg/kg acepromazine and 5 mg/kg pethidine. A dose of 5 mg/kg ketamine and 0·2 mg/kg diazepam were used for induction and isoflurane in O2 and a constant rate infusion of ketamine (20 to 30 µg/kg/minute) were administered for maintenance of general anaesthesia. Due to a twiddler's syndrome, the pacemaker had to be repositioned. For the second procedure, the same protocol was employed except for a lower dose of ketamine both for induction (3 mg/kg) and constant rate infusion (10 to 15 µg/kg/minute). Ketamine appeared to be useful for both management of anaesthesia and cardiac pacemaker implantation in the absence of a temporary pacemaker.
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Affiliation(s)
- V De Monte
- Università degli studi di Perugia, Dipartimento di Patologia, Diagnostica e Clinica Veterinaria, Sezione di Clinica Chirurgica e Radiodiagnostica, Via S. Costanzo, 4 - 06126, Perugia, Italy
| | - F Staffieri
- Università degli Studi di Bari "Aldo Moro" Dipartimento delle Emergenze e dei Trapianti di Organi Sezione di Cliniche Veterinarie e Produzioni Animali, SP per Casamassima km 3-70010, Valenzano (Bari), Italy
| | - F Birettoni
- Università degli studi di Perugia, Dipartimento di Patologia, Diagnostica e Clinica Veterinaria, Sezione di Clinica Medica, Via S. Costanzo, 4 - 06126, Perugia, Italy
| | - A Bufalari
- Università degli studi di Perugia, Dipartimento di Patologia, Diagnostica e Clinica Veterinaria, Sezione di Clinica Chirurgica e Radiodiagnostica, Via S. Costanzo, 4 - 06126, Perugia, Italy
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42
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DeFrancesco TC. Management of cardiac emergencies in small animals. Vet Clin North Am Small Anim Pract 2013; 43:817-42. [PMID: 23747262 DOI: 10.1016/j.cvsm.2013.03.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiac emergencies are life-threatening conditions that must be diagnosed quickly to avoid delays in therapy. A timely and accurate diagnosis leads to early relief of symptoms and improved survival. This article provides both a comprehensive review and updated management recommendations for common cardiac emergencies in dogs and cats. Specifically, the article confers updates for the efficient clinical recognition of decompensated cardiac patients, including focused echocardiography, cardiac biomarkers, and electrocardiogram interpretation. This article also reviews the latest recommendations for the treatment of heart failure (including the use of pimobendan) and the management of arrhythmias, pericardial effusion, and aortic thromboembolism.
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Affiliation(s)
- Teresa C DeFrancesco
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607, USA.
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43
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Visser LC, Keene BW, Mathews KG, Browne WJ, Chanoit G. Outcomes and Complications Associated With Epicardial Pacemakers in 28 Dogs and 5 Cats. Vet Surg 2013; 42:544-50. [DOI: 10.1111/j.1532-950x.2013.12020.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 06/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Lance C. Visser
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine, The Ohio State University; Columbus, OH
| | - Bruce W. Keene
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh, NC
| | - Kyle G. Mathews
- Department of Clinical Sciences; College of Veterinary Medicine, North Carolina State University; Raleigh, NC
| | - William J. Browne
- School of Veterinary Sciences; University of Bristol; Langford, Bristol; UK
| | - Guillaume Chanoit
- School of Veterinary Sciences; University of Bristol; Langford, Bristol; UK
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44
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Genovese DW, Estrada AH, Maisenbacher HW, Heatwole BA, Powell MA. Procedure times, complication rates, and survival times associated with single-chamber versus dual-chamber pacemaker implantation in dogs with clinical signs of bradyarrhythmia: 54 cases (2004–2009). J Am Vet Med Assoc 2013; 242:230-6. [DOI: 10.2460/javma.242.2.230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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de Laforcade A. Diseases associated with thrombosis. Top Companion Anim Med 2012; 27:59-64. [PMID: 23031457 DOI: 10.1053/j.tcam.2012.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/13/2012] [Indexed: 01/10/2023]
Abstract
Coagulation abnormalities are commonly encountered in critical illness. Traditionally, clinically relevant coagulation disorders have consisted mostly of bleeding associated with advanced stages of disseminated intravascular coagulation or toxin ingestion. However, advances in critical care have highlighted hypercoagulability as a clinically relevant state that must be recognized and treated to optimize the chances of a positive outcome. Retrospective studies of dogs with confirmed thrombosis in varying locations have identified populations most likely to experience hypercoagulable states. Diseases most frequently complicated by thrombosis include immune-mediated disease, neoplasia, systemic inflammation and sepsis, cardiac disease, protein-losing states, and infectious diseases. In this report, the existing retrospective studies will be discussed along with a review of specific disease processes that predispose to a hypercoagulable state. Studies targeting those populations most at risk for thrombotic complications are necessary for better understanding the need for prophylactic anticoagulant therapy.
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46
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Estrada A, Pariaut R, Hemsley S, Gatson B, Moïse N. Atrial-Based Pacing for Sinus Node Dysfunction in Dogs: Initial Results. J Vet Intern Med 2012; 26:558-64. [DOI: 10.1111/j.1939-1676.2012.00928.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/21/2012] [Accepted: 03/10/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- A.H. Estrada
- Section of Cardiology; Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville; FL
| | - R. Pariaut
- Section of Cardiology; Department of Veterinary Clinical Sciences; School of Veterinary Medicine; Louisiana State University; Baton Rouge; LA
| | - S. Hemsley
- Section of Cardiology; Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca; NY
| | - B.H. Gatson
- Section of Cardiology; Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; Gainesville; FL
| | - N.S. Moïse
- Section of Cardiology; Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca; NY
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47
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The Anatomical Basis of Bradycardia–Tachycardia Syndrome in Elderly Dogs with Chronic Degenerative Valvular Disease. J Comp Pathol 2012; 146:175-82. [DOI: 10.1016/j.jcpa.2011.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 02/07/2011] [Accepted: 03/29/2011] [Indexed: 11/21/2022]
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48
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Shoieb A, Allavena R, Swallow J, Debrue M. Peritoneal sarcomatosis associated with telemetry implants in Sprague Dawley CD rats: a review of eight cases. Toxicol Pathol 2011; 40:113-21. [PMID: 22083584 DOI: 10.1177/0192623311425063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical implantation of radiotelemetric transmitters is a current practice to collect a variety of physiological parameters in unrestrained laboratory animals, and in rodents in particular. In this study, the incidence of peritoneal sarcomatosis arising secondary to surgically implanted telemetry devices (< 15% of implanted Sprague Dawley rats) is considered to represent a significant issue for both animal welfare and data validity in affected animals. Macroscopically, the telemetry-associated fibrosarcomas spread along the visceral and parietal peritoneum and mesentery surrounding abdominal organs. The histologic morphology of these sarcomas was typically an undifferentiated sarcoma, although well-differentiated fibrosarcomas and telangiectatic and pleomorphic variants were noted. Using special stains such as Masson's Trichrome demonstrated a collagenous extracellular matrix in 50% of these rats, which is consistent with a fibroblastic origin. Immunohistochemical studies clearly delineated the mesenchymal components of the sarcomas (fibroblasts and smooth muscle cells); one case, however, was diagnosed as an osteosarcoma.
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Affiliation(s)
- Ahmed Shoieb
- Pfizer Global Research and Development, Sandwich Laboratories, Sandwich, CT13 9NJ United Kingdom.
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Implantable cardioverter-defibrillator in a German shepherd dog with ventricular arrhythmias. J Vet Cardiol 2011; 13:203-10. [DOI: 10.1016/j.jvc.2011.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/18/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE To review indications, procedures, and prognosis for common cardiovascular emergencies requiring intervention in small animals. ETIOLOGY Pericardial effusion, symptomatic bradycardia, and heartworm-induced caval syndrome are examples of clinical scenarios commonly requiring intervention. Pericardial effusion in small animals occurs most frequently from cardiac neoplasia, idiopathic pericarditis, or congestive heart failure. Indications for temporary pacing include transient bradyarrhythmias, ingestions resulting in chronotropic incompetence, and emergency stabilization of critical bradyarrhythmias. Caval syndrome results from a large dirofilarial worm burden, pulmonary hypertension, and mechanical obstruction of right-sided cardiac output with resultant hemolysis and organ dysfunction. DIAGNOSIS The diagnosis of pericardial effusion is suspected from signalment and physical findings and confirmed with cardiac ultrasound. Symptomatic bradycardias often present for syncope and definitive diagnosis derives from an ECG. Caval syndrome is diagnosed upon clinical, hematologic, and ultrasonographic evidence of severe heartworm infestation, cardiovascular compromise, and/or mechanical hemolysis. THERAPY Pericardial effusion is alleviated by pericardiocentesis in the emergency setting, though may require further intervention for long-term palliation. Temporary transvenous pacing can be performed emergently to stabilize the symptomatic patient with a bradyarrhythmia. Dirofilariasis leading to caval syndrome requires urgent heartworm extraction. PROGNOSIS The prognosis for pericardial effusion is dependent upon the underlying etiology; the prognosis for cardiac pacing is favorable, and the prognosis for caval syndrome is grave if untreated and guarded to fair if heartworm extraction is performed.
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Affiliation(s)
- Brian A Scansen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
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