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Electrical Cardioversion of Atrial Fibrillation in a Newfoun

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José Llera

on 20 February 2014

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Transcript of Electrical Cardioversion of Atrial Fibrillation in a Newfoun

Signalment & History
4 yr old, FS, Newfoundland
Presented for electrical cardioversion
Treatment for atrial fibrillation
Pathophysiology of atrial fibrillation
Tachycardia

Short refractory period of the myocardial cells

Muscle sleeve of the pulmonary veins are predisposed

Classic ECG representation:
Absent P wave
Fibrillatory waves (multiple wavelets)
Irregular R - R intervals
Electrical Cardioversion of Atrial Fibrillation in a Newfoundland
Demonstration
Physical Exam
Bright, alert and responsive
Temperature and respiratory rate normal
Rapid, irregularly irregular rhythm (140 - 200 bpm)
Variable pulse intensity
No murmur ausculted
Jose Carlos Torres LLera
Clinical Advisor: Dr. Kornreich, DVM, PhD
Pre-Clinical Advisor: Dr. Oxford, PhD, DVM

Electrocardiogram
Atrial fibrillation
140 - 200 beats per minute
Echocardiogram
Systolic function normal
No congestive heart failure
Abnormalities found:
Problem List
Atrial fibrillation
Mild Mitral regurgitation
Treatment
Electrical Cardioversion
Prognosis
Fair, based on the following:
Normal cardiac structure, no evidence of heart failure
Progressive condition
No proven means of converting to normal sinus rhythm in dogs


Based on literature, survival is shorter in male, giant/large breeds with underlying cardiac disease

If cardioversion unsuccessful, important to control ventricular response rate.
Cost
Resolved with surgical therapy
Role of opioids/pyometra in AF?
Past history of open pyometra
Unsuccesful management with medical therapy
Mild mitral regurgitation
Differential Diagnosis
Primary (lone) atrial fibrillation
Occult DCM
Mitral valve disease
Electric current resets the heart's rhythm

Success depends on the duration of atrial fibrillation

Results are inconsistent based on literature & practice

Fairly rapid reversion to
to atrial fibrillation
common in dogs, unlike in
horses

Premedication - fentanyl, induction - propofol, maintenance - isoflurane

Billateral defibrillator patches placed on the thorax

7 shocks of increasing were delivered at 5 minute intervals

Initial success, reversion to atrial fibrillation within 8 hours.

Uneventful recovery from anesthesia
Most common arrhythmia in dogs

Classification system based on temporal pattern

Large/Giant breeds are predisposed, due to:
Bigger hearts, larger depolarization area
10% of Newfoundlands present with DCM
References
1. Boos, C., Ritzema, J., More, R. (2004) A short course of oral amiodarone improves ainua rhythm maintenance post-cardioversion for atrial fibrillation. Scientific Letter. Heart 2004; 90: 1063 - 1064.

2. Wrestling, J. Westling, W., Pyle L. (2008) Epidemiology of Atrial Fibrillation in the Dog. Intern J Appl Vet Med Volume 6; 3, 151 - 154.

3. Wazni, O. Martin, D., Marrouche, N., et al. (2005) C reactive protein concentration and recurrence of atrial fibrillation after electrical cardioversion. Cardiovascular Medicine. Heart 2005; 91: 1303 - 1305.

4. Veenhuyzen, G., Simpson, C., Abdollah, H. (2004) Atrial Fibrillation. CMAJ 2004; 171: 755 - 760.

5. Kirchof, P., Lip, Kaab, S., Ezekowitz, M., Clemens, A. et al. (2012) Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options - a report from 3rd atrial fibrillation Competence NETwork/Europe Heart Rhythm Association consensus conference. Europace; 14, 8-27
Questions
Thank you very much for listening

Cardiology Service
Dr. Kornreich, DVM, PhD
Dr. Moise, DVM,MS
Dr. Oxford, PhD, DVM
Sarah Miller

Cornell Colleagues

Friends and Family
Image References
1. http://www.newfoundlanddog.org/white-newfoundland-dog-basic-information/

2. http://www.uk-ireland.bcftechnology.com/learning/small-animal/clinical-resources/cardiac-ultrasound-measurements

3. http://interactive.snm.org/img/pci/ultrasound/fig-4.jpg

4. http://www.hindawi.com/journals/crp/2012/139537.fig.003.jpg

5. http://kpiultrasound.com/components/com_virtuemart/shop_image/product/Pulse%20wave%20Doppler%20of%20right%20common%20carotid%20artery.jpg

6. http://medind.nic.in/aad/t12/i2/AnnCardAnaesth_2012_15_2_144_95080_f16.jpg


Electrical Cardioversion
Atrial Fibrillation
Pathophysiology of atrial fibrillation

Multiple reentry circuits

Reentry
obstacle
unidirectional block around obstacle
slowed conduction around obstacle


Full transcript