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Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion

Buhl, Rikke ; Hesselkilde, Eva M. ; Carstensen, Helena ; Hopster-Iversen, Charlotte ; van Loon, Gunther ; Decloedt, Annelies ; Van Steenkiste, Glenn ; Marr, Celia M ; Reef, Virginia B. and Schwarzwald, Colin C. , et al. (2022) In Equine Veterinary Journal 54(6). p.1013-1022
Abstract

Background: The recurrence rate of atrial fibrillation (AF) in horses after cardioversion to sinus rhythm (SR) is relatively high. Atrial fibrillatory rate (AFR) derived from surface ECG is considered a biomarker for electrical remodelling and could potentially be used for the prediction of successful AF cardioversion and AF recurrence. Objectives: Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Study design: Retrospective multicentre study. Methods: Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. Bipolar surface ECG recordings were analysed by... (More)

Background: The recurrence rate of atrial fibrillation (AF) in horses after cardioversion to sinus rhythm (SR) is relatively high. Atrial fibrillatory rate (AFR) derived from surface ECG is considered a biomarker for electrical remodelling and could potentially be used for the prediction of successful AF cardioversion and AF recurrence. Objectives: Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Study design: Retrospective multicentre study. Methods: Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. Bipolar surface ECG recordings were analysed by spatiotemporal cancellation of QRST complexes and calculation of AFR from the remaining atrial signal. Kaplan-Meier survival curve and Cox regression analyses were performed to assess the relationship between AFR and the risk of AF recurrence. Results: Of the 195 horses included, 74 received quinidine treatment and 121 were treated with TVEC. Ten horses did not cardiovert to SR after quinidine treatment and AFR was higher in these, compared with the horses that successfully cardioverted to SR (median [interquartile range]), (383 [367-422] vs 351 [332-389] fibrillations per minute (fpm), P <.01). Within the first 180 days following AF cardioversion, 12% of the quinidine and 34% of TVEC horses had AF recurrence. For the horses successfully cardioverted with TVEC, AFR above 380 fpm was significantly associated with AF recurrence (hazard ratio = 2.4, 95% confidence interval 1.2-4.8, P =.01). Main limitations: The treatment groups were different and not randomly allocated, therefore the two treatments cannot be compared. Medical records and the follow-up strategy varied between the centres. Conclusions: High AFR is associated with failure of quinidine cardioversion and AF recurrence after successful TVEC. As a noninvasive marker that can be retrieved from surface ECG, AFR can be clinically useful in predicting the probability of responding to quinidine treatment as well as maintaining SR after electrical cardioversion.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Equine Veterinary Journal
volume
54
issue
6
pages
1013 - 1022
publisher
Equine Veterinary Journal Ltd
external identifiers
  • scopus:85122746104
  • pmid:34957586
ISSN
0425-1644
DOI
10.1111/evj.13551
language
English
LU publication?
yes
id
7b358d5d-913f-4979-a771-4d0bca773908
date added to LUP
2022-03-07 14:40:26
date last changed
2024-06-21 15:51:09
@article{7b358d5d-913f-4979-a771-4d0bca773908,
  abstract     = {{<p>Background: The recurrence rate of atrial fibrillation (AF) in horses after cardioversion to sinus rhythm (SR) is relatively high. Atrial fibrillatory rate (AFR) derived from surface ECG is considered a biomarker for electrical remodelling and could potentially be used for the prediction of successful AF cardioversion and AF recurrence. Objectives: Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Study design: Retrospective multicentre study. Methods: Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. Bipolar surface ECG recordings were analysed by spatiotemporal cancellation of QRST complexes and calculation of AFR from the remaining atrial signal. Kaplan-Meier survival curve and Cox regression analyses were performed to assess the relationship between AFR and the risk of AF recurrence. Results: Of the 195 horses included, 74 received quinidine treatment and 121 were treated with TVEC. Ten horses did not cardiovert to SR after quinidine treatment and AFR was higher in these, compared with the horses that successfully cardioverted to SR (median [interquartile range]), (383 [367-422] vs 351 [332-389] fibrillations per minute (fpm), P &lt;.01). Within the first 180 days following AF cardioversion, 12% of the quinidine and 34% of TVEC horses had AF recurrence. For the horses successfully cardioverted with TVEC, AFR above 380 fpm was significantly associated with AF recurrence (hazard ratio = 2.4, 95% confidence interval 1.2-4.8, P =.01). Main limitations: The treatment groups were different and not randomly allocated, therefore the two treatments cannot be compared. Medical records and the follow-up strategy varied between the centres. Conclusions: High AFR is associated with failure of quinidine cardioversion and AF recurrence after successful TVEC. As a noninvasive marker that can be retrieved from surface ECG, AFR can be clinically useful in predicting the probability of responding to quinidine treatment as well as maintaining SR after electrical cardioversion.</p>}},
  author       = {{Buhl, Rikke and Hesselkilde, Eva M. and Carstensen, Helena and Hopster-Iversen, Charlotte and van Loon, Gunther and Decloedt, Annelies and Van Steenkiste, Glenn and Marr, Celia M and Reef, Virginia B. and Schwarzwald, Colin C. and Mitchell, Katharyn J. and Nostell, Katarina and Nogradi, Nora and Nielsen, Søren S. and Carlson, Jonas and Platonov, Pyotr G}},
  issn         = {{0425-1644}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1013--1022}},
  publisher    = {{Equine Veterinary Journal Ltd}},
  series       = {{Equine Veterinary Journal}},
  title        = {{Atrial fibrillatory rate as predictor of recurrence of atrial fibrillation in horses treated medically or with electrical cardioversion}},
  url          = {{http://dx.doi.org/10.1111/evj.13551}},
  doi          = {{10.1111/evj.13551}},
  volume       = {{54}},
  year         = {{2022}},
}