Treatment of supraventricular tachycardia in a horse

Detection of the origin of atrial tachycardia by 3D electro-anatomical mapping and treatment by radiofrequency catheter ablation in horses

Background

Atrial tachycardia (AT) can be treated by medical or electrical cardioversion but the recurrence rate is high. Three‐dimensional electro‐anatomical mapping, recently described in horses, might be used to map AT to identify a focal source or reentry mechanism and to guide treatment by radiofrequency ablation.

Objectives

To describe the feasibility of 3D electro‐anatomical mapping and radiofrequency catheter ablation to characterize and treat sustained AT in horses.

Animals

Nine horses with sustained AT.

Methods

Records from horses with sustained AT referred for radiofrequency ablation at Ghent University were reviewed.

Results

The AT was drug resistant in 4 out of 9 horses. In 8 out of 9 horses, AT originated from a localized macro‐reentrant circuit (n = 5) or a focal source (n = 3) located at the transition between the right atrium and the caudal vena cava. In these 8 horses, local radiofrequency catheter ablation resulted in the termination of AT. At follow‐up, 6 out of 8 horses remained free of recurrence.

Conclusions and Clinical Importance

Differentiation between focal and macro‐reentrant AT in horses is possible using 3D electro‐anatomical mapping. In this study, the source of right atrial AT in horses was safely treated by radiofrequency catheter ablation.

Atrial fibrillation in horses Part 2: Diagnosis, treatment and prognosis

Atrial fibrillation (AF) is suspected by an irregularly irregular rhythm during auscultation at rest and should be confirmed by electrocardiography. Heart rate monitoring is potentially interesting for AF detection by horse owners, based on the disproportionally high heart rate during exercise or increased heart rate variability. Echocardiography and laboratory analysis are useful to identify underlying cardiac disease. Horses with severe cardiac disease should not undergo cardioversion due to the risk of recurrence. Cardioversion is recommended especially in horses performing high intensity exercise or showing average maximal heart rates higher than 220 beats per min or abnormal ventricular complexes during exercise or stress. Pharmacological cardioversion can be performed using quinidine sulphate administered orally, with an overall mean reported success rate around 80%. Other therapeutic drugs have been described such as flecainide, amiodarone or novel atrial specific compounds. Transvenous electrical cardioversion (TVEC) is performed by delivering a shock between two cardioversion catheters positioned in the left pulmonary artery and right atrium, with a success rate of >95%. After cardioversion, most horses return to their previous level of performance. However, the recurrence rate after pharmacological or electrical cardioversion is up to 39%. Recurrence has been related to previous unsuccessful treatment attempts, valvular regurgitation and the presence of atrial premature depolarisations or low atrial contractile function after cardioversion. Large atrial size and long AF duration have also been suggested as risk factors. Different approaches for preventing recurrence have been described such as the administration of sotalol, however, large clinical studies have not been published.