Localization and characterization of atrial depolarization waves on the surface electrocardiogram in dogs with rapid supraventricular tachycardia

BACKGROUND

Supraventricular tachycardias (SVTs), despite having various anatomical substrates and pathophysiological mechanisms, frequently show similar electrocardiographic presentations.

OBJECTIVES

To locate and characterize atrial deflections (ADs) on 12-lead electrocardiograms in dogs with sustained rapid SVT and assess the utility of different electrocardiographic variables in differentiating types of tachycardia.

ANIMALS

Ninety-two dogs with orthodromic atrioventricular reciprocating tachycardia, 17 with atrial flutter, 33 with focal atrial tachycardia recorded and confirmed by electrophysiological study, and 40 dogs with sinus tachycardia.

METHODS

Atrial deflection position on the 12-lead surface electrocardiogram was assessed according to the sequence of intracardiac activation. Its features were evaluated together with the relationship between AD and QRS complex interval (AD-R) and QRS complex and AD interval (R-AD).

RESULTS

Orthodromic atrioventricular reciprocating tachycardia was characterized by an AD-AD interval of 213 ± 30 ms, mean electrical axis (MEA) of AD of -90 (-90/-78)°, R-AD interval of 75 (65-80) ms, and R-AD/AD-R of 0.54 (0.45-0.64). Atrial flutter was characterized by an AD-AD interval of 199 ± 57 ms, MEA of 76° (72/81), R-AD of 120 (72-144) ms, and R-AD/AD-R of 0.81 (0.63-1.13). Focal atrial tachycardia was characterized by an AD-AD interval of 270 ± 38 ms, MEA of 49 (-72/76)°, R-AD of 160 (120-200) ms, and R-AD/AD-R of 1.45 (0.92-1.67). Sinus tachycardia was characterized by an AD-AD interval of 292 ± 31 ms, MEA of 66° (52/73), R-AD of 215 (192-222) ms, and R-AD/AD-R of 2.68 (2.25-3.08).

CONCLUSIONS AND CLINICAL IMPORTANCE

Analyzing AD on 12-lead electrocardiogram is helpful in differentiating the most common SVTs in dogs.

Anatomic distribution and electrophysiologic properties of accessory atrioventricular pathways in dogs

OBJECTIVE

To evaluate the anatomic distribution and electrophysiologic properties of accessory pathways (APs) in dogs.

DESIGN

Case series.

ANIMALS

10 dogs with tachyarrhythmias associated with an AP.

PROCEDURES

Each dog underwent electrophysiologic testing to determine the inducibility of documented and undocumented arrhythmias and to identify location, conduction properties, and antegrade and retrograde effective refractory periods of the APs. Radiofrequency catheter ablation was then performed.

RESULTS

15 APs were identified; 7 dogs each had a single AP, and 3 had multiple APs. Fourteen of the 15 APs were right-sided (6 right free wall, 4 posteroseptal, 3 midseptal, and 1 anteroseptal), and 1 was left-sided (left free wall). All APs conducted in an all-or-none fashion. Unidirectional retrograde conduction was observed in 11 APs, and bidirectional conduction was observed in 4. All documented tachyarrhythmias could be induced during electrophysiologic testing; atrial fibrillation was also inducible in 2 dogs. Mean +/- SD cycle duration of orthodromic atrioventricular reciprocating tachycardia was 215.80 +/- 44.87 milliseconds. Mean shortest R-R interval during atrial fibrillation was 247.33 +/- 83.17 milliseconds.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that in dogs, most APs are right-sided, had unidirectional retrograde conduction, and are associated with various arrhythmias, including orthodromic atrioventricular reciprocating tachycardia and atrial fibrillation without evidence of pre-excitation.

Tachycardia-induced cardiomyopathy in a young Boxer dog with supraventricular tachycardia due to an accessory pathway

A 1-year-old male Boxer dog presented with sustained supraventricular tachycardia and tachycardia-induced cardiomyopathy. Conversion to sinus rhythm was achieved initially with intravenous lignocaine and subsequently with oral procainamide. Oral procainamide treatment was relatively successful in maintaining normal sinus rhythm with no side effects apart from a reversible change in coat colour. Electrophysiological studies demonstrated the presence of an accessory pathway connecting the right atrium to the right ventricle and confirmed the diagnosis of orthodromic atrioventricular reciprocating tachycardia. Radiofrequency catheter ablation of the accessory pathway led to permanent resolution of the supraventricular tachycardia and for 9.5 years the dog has had no further signs of cardiac disease. The successful treatment of this condition highlights the importance of differentiating tachycardia-induced cardiomyopathy from dilated cardiomyopathy.

Cardioversion of supraventricular tachycardia using lidocaine in five dogs

Sustained supraventricular tachycardia (SVT) may lead to life-threatening complications such as tachycardia-induced myocardial failure. We report the use of intravenous lidocaine in 5 dogs with SVT. Two dogs had evidence of an accessory conduction pathway, 2 were suspected of having an accessory pathway, and the mechanism of SVT was unknown in the remaining dog, which subsequently developed dilated cardiomyopathy 2 years later. In all cases there was rapid conversion to normal sinus rhythm, which was then maintained with oral mexilitene (4 dogs) or mexilitene combined with propranolol (1 dog).

Ambulatory electrocardiography in dogs

Twenty-four hour ambulatory electrocardiographic recording using a Medilog tape recorder was attempted in 16 healthy pet dogs weighing between 18.4 and 34 kg, while they were living in familiar surroundings. Full 24-hour records were obtained from 10 of them and recordings of more than 10 hours duration from two others; and the findings in these recordings were similar. Maximum heart rates ranged between 110 and 300 beats/minute and the minimum rates ranged between 17 and 46 beats/minute. Intermittent ventricular premature complexes were recorded from these apparently healthy dogs and all but one dog demonstrated a sinus pause, longer than two seconds; the longest pause was 5.7 seconds. The pauses were associated with marked sinus arrhythmia and occurred in both brachycephalic and non-brachycephalic breeds.

Sustained supraventricular tachycardia in a horse

A case of sustained supraventricular tachycardia of unknown aetiology in a two-year-old Thoroughbred filly is reported. The cardiac dysrhythm was successfully treated by the oral administration of quinidine sulphate. Conversion of the dysrhythm to sinus rhythm occurred approximately 80 min after the initial dose of 5 g of quinidine sulphate. The horse returned to training approximately 2 months after treatment and has since successfully returned to racing.

Verapamil administration for acute termination of supraventricular tachycardia in dogs

Verapamil, a calcium channel-blocking drug, was administered IV at a dosage that ranged from 0.05 to 0.15 mg/kg of body weight to 14 dogs with supraventricular tachycardia. The dosage was titrated, administering 0.05 mg/kg every 5 to 30 minutes following the initial 0.05 mg/kg dose in all but 1 dog. The drug terminated the arrhythmia in 12 dogs and slowed the ventricular rate in 1 dog. One dog was unresponsive to verapamil administration and became transiently hypotensive after the administration of a total dose of 0.15 mg/kg over 5 to 6 minutes. Various arrhythmias occurred after verapamil administration, but none required additional treatment or caused serious sequelae. Verapamil was an effective treatment for acutely converting supraventricular tachycardia to sinus rhythm in these dogs. It appears to be safe when administered in the aforementioned dosage range.

New perspectives in cardiovascular medicine: the calcium channel blocking drugs

Calcium channel blocking drugs reduce the influx of calcium (Ca++) through cell membrane passageways in excitable tissues. This unique pharmacodynamic action represents an important new addition to cardiovascular therapeutics. Clinically available members of this diverse group of compounds are verapamil, nifedipine, and diltiazem. Beneficial responses to these drugs can be explained by vasodilatation and resulting hemodynamic improvement in tissue perfusion-oxygen demand relationships, by suppression of Ca++-dependent arrhythmogenic mechanisms, by direct reduction of pathologic Ca++ overload in ischemic injured cells, or by a combination of these effects. Calcium channel blockade already has become a therapeutic mainstay in human medicine for management of ischemic heart disease and some forms of cardiac dysrhythmias. Relative to veterinary medicine, Ca++ channel blocking drugs may provide a clinical option for controlling supraventricular tachyarrhythmias. Other indications might include obstructive cardiomyopathies, shock-trauma, and congestive heart failure. Importantly, however, essential issues about adverse cardiovascular side effects of Ca++ channel blocking drugs remain unresolved and controversial. Recent studies especially have raised questions about the tendency for Ca++ channel blockade to exacerbate preexisting or occult myocardial contractile failure. Such pharmacodynamic complexities should be assessed judiciously as the Ca++ channel blocking drugs are appraised for entry into veterinary internal medicine.