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Electrical Cardioversion of Atrial Fibrillation in a Newfoun
Transcript of Electrical Cardioversion of Atrial Fibrillation in a Newfoun
4 yr old, FS, Newfoundland
Presented for electrical cardioversion
Treatment for atrial fibrillation
Pathophysiology of atrial fibrillation
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
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
140 - 200 beats per minute
Systolic function normal
No congestive heart failure
Mild Mitral regurgitation
Fair, based on the following:
Normal cardiac structure, no evidence of heart failure
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.
Resolved with surgical therapy
Role of opioids/pyometra in AF?
Past history of open pyometra
Unsuccesful management with medical therapy
Mild mitral regurgitation
Primary (lone) atrial fibrillation
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
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
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
Thank you very much for listening
Dr. Kornreich, DVM, PhD
Dr. Moise, DVM,MS
Dr. Oxford, PhD, DVM
Friends and Family
Pathophysiology of atrial fibrillation
Multiple reentry circuits
unidirectional block around obstacle
slowed conduction around obstacle