Ventricular pre-excitation in cats: 17 cases.

OBJECTIVES: Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias. ANIMALS: Seventeen cats with VPE and 15 healthy matched-control cats. MATERIAL AND METHODS: Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated. RESULTS: Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]). CONCLUSIONS: Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats.

Investigation of ventricular pre-excitation electrocardiographic pattern in two horses: clinical presentation and potential causes.

Two horses referred to the Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, for unrelated clinical problems, and with no previous history of cardiac disease exhibited an intermittent ventricular pre-excitation electrocardiographic pattern during hospitalization. Both animals showed decreased plasma total and ionized magnesium concentrations, but no other relevant electrolyte disturbances were detected. Altered interventricular septal motion associated with ventricular pre-excitation beats (VPBs) was detected on M-mode echocardiography in both horses. The likely localization of an accessory pathway (AP) was identified in case 2 using pulsed-wave tissue Doppler imaging in the left anterior paraseptal location. Decreased frequency of the VPB was observed with long-term magnesium supplementation and restoration of plasma magnesium concentrations. The presence of ventricular pre-excitation electrocardiographic pattern was attributed to higher sensitivity of the AP to hypomagnesemia in both cases.

An accessory bypass tract masked by the presence of atrial fibrillation in a horse.

Accessory bypass tracts are rarely documented in horses. Here, we present a case of an accessory bypass tract which was initially masked by the presence of atrial fibrillation. Evidence of ventricular pre-excitation was recognized after cardioversion to normal sinus rhythm and the horse was diagnosed with Wolff-Parkinson-White Syndrome. In people, atrial fibrillation in the presence of an accessory bypass tract is considered dangerous due to the risk of sudden cardiac death. Although we did not consider this horse safe to ride, he continues to compete successfully and has not had recurrence of clinically significant tachyarrhythmias.

The Wolff-Parkinson-White syndrome in a Holstein-Friesian cow.

A case of Wolff-Parkinson-White (WPW) syndrome in a Holstein-Freisian cow aged 10-year-old was examined in detail. In electrocardiogram (ECG), the P-wave was the same configuration in both the normal and abnormal ECG. The PR-interval shortened from 0.2 to 0.1 second and the duration of the QRS-complex prolonged from 0.1 to 0.12 second compared with normal ECG. The delta wave, characterized in WPW syndrome, could not be recognized. In echocardiogram, notches were recognized at the early stage of ventricular contraction in the interventricular septum. This cow was, therefore, diagnosed as type B WPW syndrome. The abnormal ECG disappeared by the administration of procainamide. It was strongly indicated that the ventricular contraction showing abnormal ECG was generated only by the stimulation through an accessory pathway in this cow.

Electrophysiological studies on atrial fibrillation.

We tested the multiple-wavelet hypothesis by studying the initiation and maintenance of atrial fibrillation in normal mules, horses, cows, calves, and goats. Persistence of atrial fibrillation in animals with a large atrial mass was compared with results in adult goats and calves having a smaller atrial mass. Atrial stimulation in clinically normal cows, mules, calves, and goats was accomplished using an intra-atrial stimulating catheter with rapid atrial pacing (30/s). Once initiated, atrial fibrillation persisted for 95,120,125 min, 3 days, and 8 weeks in five adult cows, respectively. In contrast, in five calves, atrial fibrillation failed to persist for more than a few minutes. Similar results were found in the small atria of adult goats, indicating that atrial size rather than maturity of the atrial myocardium was responsible. In addition, to demonstrate that this was not a species-dependent phenomenon, it was shown in adult mules that atrial fibrillation could persist for 24 h or more once initiated. These studies are consistent with the multiple-wavelet hypothesis for initiation and maintenance of atrial fibrillation. We also studied the ventricular response in atrial fibrillation. We found that as many as nine consecutive atrial responses can be concealed within the atrioventricular (AV) node associated with a long R-R interval during atrial fibrillation. Although concealment of rapid atrial activity normally occurred in the AV node, one case of infranodal block was observed. It has also been suggested that subsidiary AV junctional pacemakers may be the cause of the ventricular irregularity. However, our experimental studies using microelectrodes in isolated tissue and extracellular bundle of His recordings in intact animals failed to demonstrate that this mechanism was responsible for the irregularity of the ventricular response in atrial fibrillation.

The Wolff-Parkinson-White-syndrome. A rare ECG diagnosis in the dog.

A case of the rare heart disease Wolf-Parkinson-White-syndrome in the dog is described. ECG-findings typical of the syndrome are shortened P-R interval, widened QRS-complex with an initial delta-wave, and supraventricular tachycardia. Pre- (Fig. 1) and post-treatment (Fig. 2) ECG's are analyzed. Different kinds of treatment are discussed.