Echocardiographic Evidence of Left Atrial Mechanical Dysfunction after Conversion of Atrial Fibrillation to Sinus Rhythm in 5 Horses

Abstract

Atrial contractile dysfunction occurs in some species after conversion of atrial fibrillation (AF) to normal sinus rhythm (NSR) but has not been reported in horses with naturally occurring AF. Transthoracic echocardiography allows detection of left atrial (LA) mechanical dysfunction in horses after conversion of AF to NSR. Five Standardbreds with AF and 6 healthy Standardbreds of similar age, weight, and athletic condition were included in this study. Four horses were treated pharmacologically (quinidine), and 1 horse was treated by means of transvenous electrical cardioversion. Echocardiographic examinations were performed in normal horses (once) and in AF horses (24 hours and 72 hours after conversion to NSR) by means of 2-dimensional echocardiography (2DE), transmitral flow Doppler, and tissue Doppler imaging (TDI) techniques. Echocardiographic indices of LA mechanical function were compared between normal horses and AF horses. Two-dimensional echocardiography and TDI indices of LA mechanical function revealed significant decreases in LA contractile function and LA reservoir function 24 hours after cardioversion. This decrease was no longer statistically significant 72 hours after cardioversion, but changes in echocardiographic variables between 24 and 72 hours varied among horses. LA contractile dysfunction can be evaluated in horses by use of 2DE, transmitral Doppler flow velocity profiles, and analyses of LA wall motion by TDI. The results of this study are consistent with AF-induced atrial remodeling, although residual treatment effects or influence of underlying primary myopathy cannot be excluded.