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

Rikke Buhl,Pyotr G Platonov,Annelies Decloedt,Gunther Van Loon,Nora Nogradi,Søren S Nielsen,Katharyn J Mitchell,Jonas Carlson,Colin C Schwarzwald,Charlotte Hopster‐Iversen,Celia M Marr,Glenn Van Steenkiste,Helena Carstensen,Eva M Hesselkilde,Katarina Nostell,Virginia B Reef

doi:10.1111/evj.13551

Abstract

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. Evaluate if AFR was associated with successful treatment and could predict AF recurrence in horses. Retrospective multicentre study. 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. 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 180days 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). 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. 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.

Highlights

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in horses with an estimated prevalence of 0.1%-2.5% depending on breed and the sample studied.[1,2,3,4] Atrial fibrillation is associated with substantially reduced athletic performance[5,6] and is a clinically important disease
For the horses successfully cardioverted with transvenous electrical cardioversion (TVEC), Atrial fibrillatory rate (AFR) above 380 fpm was significantly associated with atrial fibrillation (AF) recurrence
High AFR is associated with failure of quinidine cardioversion and AF recurrence after successful TVEC

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in horses with an estimated prevalence of 0.1%-2.5% depending on breed and the sample studied.[1,2,3,4] Atrial fibrillation is associated with substantially reduced athletic performance[5,6] and is a clinically important disease. 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. Methods: Electrocardiograms (ECG) from horses with persistent AF admitted for cardioversion with either medical treatment (quinidine) or transvenous electrical cardioversion (TVEC) were included. 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

Objectives

Methods

Findings

Conclusion