Comparison of in-hospital versus 24-hour ambulatory electrocardiography for detection of ventricular premature complexes in mature Boxers

OBJECTIVE: To evaluate the use of in-hospital electrocardiography (ECG) for detection of ventricular premature complexes (VPC), compared with 24-hour ambulatory ECG. DESIGN: Original study. ANIMALS: 188 Boxers > 9 months old; 31 had a history of syncope, and 157 were healthy (no history of syncope). PROCEDURE: In-hospital ECG was performed on all Boxers for at least 2 minutes. Within 7 days after the in-hospital ECG was completed, 24-hour ambulatory ECG was performed. RESULTS: The specificity of in-hospital ECG was 100% for the detection of at least 50 VPC in a 24-hour period in dogs with syncope and 93% in healthy dogs. In-hospital ECG had poor sensitivity, although sensitivity increased as the number of VPC per 24 hours increased. CONCLUSIONS AND CLINICAL RELEVANCE: Use of in-hospital ECG is highly specific for detection of at least 50 VPC during a 24-hour period. However, in-hospital ECG is insensitive, and a lack of VPC does not suggest that the dog does not have a substantial number of VPC during that same period. The use of in-hospital ECG appears to be inadequate for screening purposes and therapeutic evaluations in mature Boxers with ventricular arrhythmic disease.     

Results of ambulatory electrocardiography in overtly healthy Doberman Pinschers with echocardiographic abnormalities

OBJECTIVE: To identify, by means of 24-hour ambulatory electrocardiography, electrocardiographic abnormalities in overtly healthy Doberman Pinschers in which results of echocardiography were abnormal. DESIGN: Clinical case series. ANIMALS: 56 (35 male, 21 female) overtly healthy Doberman Pinschers with echocardiographic evidence of cardiomyopathy on initial examination that subsequently died of cardiomyopathy. PROCEDURE: Twenty-four-hour ambulatory electrocardiographic (Holter) recordings obtained at the time of initial examination were reviewed. For all dogs, scan quality was > 90%. RESULTS: Initial Holter recordings of all 56 dogs contained ventricular premature contractions (VPC). Thirty-six (65%) dogs had > 1,000 VPC/24 h, 17 (31%) had > 5,000 VPC/24 h, and 11 (19%) had > 10,000 VPC/24 h. Fifty-four (96%) dogs had couplets of VPC, 37 (66%) had triplets of VPC, and 36 (64%) had episodes of nonsustained (< 30 seconds) ventricular tachycardia. Number of VPC/24 h during the initial Holter recordings was positively correlated with numbers of couplets and triplets of VPC and number of ventricular escape beats and negatively correlated with left ventricular fractional shortening. Twenty-eight dogs died suddenly prior to the putative onset of congestive heart failure. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that along with echocardiography, 24-hour ambulatory electrocardiography can be used to help identify overtly healthy Doberman Pinschers with cardiomyopathy.     

Ambulatory electrocardiography in dogs

Twenty-four hour ambulatory electrocardiographic recording using a Medilog tape recorder was attempted in 16 healthy pet dogs weighing between 18.4 and 34 kg, while they were living in familiar surroundings. Full 24-hour records were obtained from 10 of them and recordings of more than 10 hours duration from two others; and the findings in these recordings were similar. Maximum heart rates ranged between 110 and 300 beats/minute and the minimum rates ranged between 17 and 46 beats/minute. Intermittent ventricular premature complexes were recorded from these apparently healthy dogs and all but one dog demonstrated a sinus pause, longer than two seconds; the longest pause was 5.7 seconds. The pauses were associated with marked sinus arrhythmia and occurred in both brachycephalic and non-brachycephalic breeds.     

Evaluation of cardiac rhythm in dogs treated with levamisole hydrochloride using 24-hour ambulatory electrocardiography

The objective of this study was to evaluate the electrocardiographic alterations in the cardiac rhythm in dogs treated with levamisole hydrochloride over a period of 24 hours. Thirty-six mixed-breed dogs, both male and female, all clinically healthy, were used in the experiment. The dogs were divided into 6 groups with 6 dogs in each group, according to dosage and route of administration. The Holter test was initiated immediately after the treatment, and was maintained for 24 hours. In the group treated with 10 mg/kg by way of subcutaneous injection, one of them showed ventricular premature complexes, sometimes isolated and other times in pairs, and ventricular tachycardia, concentrated mainly in the first hour after administration of the drug. In the group of 6 animals treated subcutaneously with 25mg/kg, four showed isolated ventricular premature complexes, ventricular bigeminy and trigeminy, mainly during the first 2 hours after administration of the drug. All the animals in the other groups showed sinus arrhythmia followed by sinus arrest. The disturbances in the cardiac rhythm observed in clinically healthy animals treated with levamisole hydrochloride, indicate that it is preferable to avoid subcutaneous administration of levamisole hydrochloride and that the oral administration of the drug should be done with caution.     

Results of ambulatory electrocardiography in overtly healthy Doberman Pinschers with equivocal echocardiographic evidence of dilated cardiomyopathy

OBJECTIVE: To determine results of ambulatory electrocardiography in and outcome of overtly healthy Doberman Pinschers with equivocal echocardiographic evidence of dilated cardiomyopathy. DESIGN: Case series. ANIMALS: 44 overtly healthy (25 male, 19 female) Doberman Pinschers. PROCEDURE: 24-hour ambulatory electrocardiographic (Holter) recordings with > 90% scan quality obtained the same day that echocardiography was performed were reviewed. RESULTS: Holter recordings from 42 of 44 (95%) dogs contained ventricular premature complexes (VPC). Fifteen of 44 (34%) dogs had > 100 VPC, 9 (20%) had > 500 VPC, and 5 (11%) had > 1,000 VPC. Nonsustained (< 30 seconds) ventricular tachycardia was detected in 4 dogs. Eighteen of 27 (67%) dogs with > 100 VPC, any couplets or triplets of VPC, or ventricular tachycardia developed dilated cardiomyopathy within 1 year, compared with 8 of 17 (47%) dogs with < 100 VPC, no couplets or triplets of VPC, and no ventricular tachycardia. Of the 18 dogs that did not develop dilated cardiomyopathy within 1 year, 11 (61%) did so within 3 years. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a high percentage of Doberman Pinschers with equivocal echocardiographic evidence of dilated cardiomyopathy will be found to have VPC during 24-hour ambulatory electrocardiography and that most will develop echocardiographic abnormalities indicative of cardiomyopathy.     

Results of 24-hour ambulatory electrocardiography in dogs undergoing ovariohysterectomy following premedication with medetomidine or acepromazine

OBJECTIVE: To investigate heart rate characteristics in dogs undergoing ovariohysterectomy following premedication with medetomidine or acepromazine. DESIGN: Clinical trial. ANIMALS: 43 client-owned dogs. PROCEDURE: 24-hour ambulatory electrocardiography was performed beginning approximately 1 hour prior to administration of premedications. Dogs were premedicated with medetomidine and butorphanol (n = 21) or acepromazine and butorphanol (22) and, approximately 85 minutes later, were anesthetized with propofol and isoflurane. Electrocardiographic recordings were examined to determine heart rate, cardiac conduction disturbances (ventricular premature complexes and atrioventricular block), and indices of heart rate variability (HRV). RESULTS: Minimum heart rate during the 24-hour recording period was significantly lower among dogs given medetomidine than among dogs given acepromazine, but during the postoperative period, heart rate increased in all dogs as they became physically active. Intraoperative time domain HRV indices were lower and the low frequency-to-high frequency ratio was higher among dogs given acepromazine than among dogs given medetomidine; however, significant differences between groups were no longer seen by 6 hours after surgery. There was no significant difference between groups with regard to the number of ventricular premature complexes or to values of scaling exponent alpha2 (a nonlinear measure of HRV). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that there are greater enhancements in vagally related heart rate indices in medetomidine-treated dogs that may persist until 6 hours after surgery. Despite the low heart rates, dogs given medetomidine showed expected responses to surgery and positional stimuli, and the 2 preanesthetic protocols may not result in different prevalences of ventricular premature complexes.     

Oesophageal electrocardiography in healthy horses

Reasons for performing study: In human medicine, oesophageal electrocardiography (ECG) is a well‐established technique that magnifies P waves with respect to the QRS complex. Objectives: To investigate the feasibility of oesophageal ECG recording in horses and its ability to produce larger P waves compared with base‐apex and unipolar recordings. Methods: Bipolar and unipolar ECG were performed using oesophageal and surface electrodes. Oesophageal ECG was obtained from 6 different recording configurations at different oesophageal depths. Amplitudes of P, Q, R, S and T waves were measured from 3 different cardiac cycles for each recording configuration and depth. Results: Oesophageal ECG was feasible in all horses. For all oesophageal recording configurations, significantly larger P waves were recorded from a depth that equalled ‘height of the withers + 10 cm’ (HW₊₁₀) than from any other depth. P/QRS_magn, the ratio between the P wave and QRS complex magnitudes, was largest for intraoesophageal recordings with an interelectrode distance of 10 cm, at HW₊₁₀, where it was significantly larger than base‐apex and unipolar recordings. Base‐apex recording resulted in significantly smaller P waves than all other recording configurations and significantly smaller P/QRS_magn ratios than all other recording configurations except one combined oesophageal‐surface recording (E/S_low). Conclusions: Oesophageal ECG recording is feasible in horses and effective in magnifying P wave amplitude. Potential relevance: The procedure is promising for diagnosis of supraventricular tachydysrhythmias and might be used in electrophysiological studies and for cardiac pacing.     

Use of signal-averaged electrocardiography in the evaluation of arrhythmogenic right ventricular cardiomyopathy in boxers

OBJECTIVE: To assess signal-averaged electrocardiography (SAECG) for evaluation of Boxers with arrhythmogenic right ventricular cardiomyopathy (ARVC) and identify dogs at risk for sudden death (SD) or death related to congestive heart failure (CHF). DESIGN: Prospective study. ANIMALS: 94 Boxers with ARVC and 49 clinically normal non-Boxers (controls). PROCEDURE: Boxers were screened for ARVC, and severity was estimated by use of echocardiography, 24-hour ambulatory ECG, and SAECG. Statistical evaluation was performed to identify significant differences in SAECG variables relative to clinical outcome, frequency of ventricular arrhythmias, and systolic function. Sensitivity, specificity, and positive and negative predictive values were evaluated for each SAECG variable for occurrence of SD or death related to CHF. Late potentials were also evaluated as a predictor of cardiac-related death. RESULTS: Differences were detected in SAECG variables on the basis of clinical outcome, systolic function, and frequency of ventricular arrhythmias. More severely affected dogs had significantly more abnormal SAECG findings. The presence of late potentials, defined as 2 abnormal root mean square values (of 4), was associated with high sensitivity, specificity, and negative predictive value for cardiac-related SD or death secondary to CHF CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that SAECG is a useful noninvasive diagnostic test to evaluate dogs affected with ARVC and identify individuals at risk for cardiac-related death.     

Ventriculo-atrial conduction in the ovine heart,caused by premature ventricular complexes

In humans, and certain animals, the atrioventricular conduction system is capable of bidirectional conduction. Depolarization impulses, originating in the ventricle itself, may thus be conducted in a retrograde direction towards the atria. Two common causes for this phenomenon of ventriculo-atrial (retrograde) conduction are premature ventricular complexes and ventricular pacing. The surface electrocardiogram can be used for the detection of such retrogradely conducted beats. The purpose of this study was to investigate the possibility of ventriculo-atrial conduction in Dorper sheep. Premature ventricular complexes in eight healthy Dorper wethers were induced and it was possible to document retrogradely conducted beats on the surface electrocardiogram in all of them. It is concluded that the Dorper sheep heart is capable of ventriculo-atrial conduction.     

The Brody effect induced by premature ventricular complexes in the ovine heart

The QRS response of the electrocardiogram to bleeding has been a source of interest to the physiologist for more than a century. Studies in the dog, cat and chicken have shown a reduction in QRS amplitude in response to bleeding. This effect has been explained by the so-called Brody effect, in which the intraventricular mass of blood acts as a conducting medium, augmenting radial conduction, thus resulting in the subsequent reduction in QRS amplitude in conditions where the intraventricular mass of blood is reduced. The aim of this study was to evaluate whether the Brody effect will be present in the ovine heart and, furthermore, to evaluate if the right and left ventricles will demonstrate the same QRS change if the Brody effect is indeed present. This study clearly demonstrated that the Brody effect is present in the ovine heart. Furthermore, two unique aspects emanating from this study are firstly the fact that this is the first study to show that premature ventricular complexes are able to induce the Brody effect and, secondly that there is a very clear difference in the response of the right and the left ventricles when the Brody effect is induced in the ovine heart.     

Use of a point-of-care beta-hydroxybutyrate sensor for detection of ketonemia in dogs

The urine test strip is the most common test used to detect ketones in veterinary patients, but it can underestimate the degree of ketonuria and hence, ketonemia. Additionally, adequate urine samples for analysis may be difficult to obtain from dehydrated animals. The standard method used to detect and monitor ketonemia in human medicine is measurement of serum or whole blood beta-hydroxybutyrate (βHOB). A point-of-care (POC) analyzer has been validated for this purpose in humans. This study compared the accuracy of the POC device to an enzymatic reaction laboratory method for measurement of βHOB in dogs. Although the POC sensor tended to overestimate βHOB concentrations, there was good correlation (R(2) = 0.96) and good agreement between the 2 methods with a bias +/- precision of 0.0860 +/- 0.3410 mmol/L βHOB. The POC βHOB sensor can be useful for assessing ketonemia in dogs.     

Pulsed tissue Doppler imaging of the left ventricular septal mitral annulus in healthy dogs

This study evaluated pulsed TDI variables including the isovolumic time interval and duration of the major wave in a population of large healthy dogs. Longitudinal myocardial motion at the septal mitral annulus was evaluated with pulsed TDI in 45 healthy adult dogs. Maximal myocardial velocities, isovolumic time intervals, and duration of the myocardial waves were measured. The correlation between time intervals and velocity variables was also investigated. The mean maximal systolic velocity was 6.92 ± 1.78 cm/sec, the mean early diastolic velocity (Em) was 6.58 ± 1.81 cm/sec, the mean late diastolic velocity (Am) was 5.10 ± 2.00 cm/sec, the mean isovolumic contraction time (IVCT) was 53.61 ± 95.13 msec, and the mean isovolumic relaxation time (IVRT) was 26.74 ± 57.24 msec. The early diastolic mitral inflow velocity (E)/Em ratio was 10.94 ± 3.27 while the Em/Am ratio was 1.40 ± 0.40. There was a negative correlation between Am duration and Am amplitude, and a positive correlation between the IVRT and Em/Am ratio (p < 0.05). The normal LV parameter using pulsed TDI method could be used as the reference range for identifying myocardial dysfunction in dogs.     

Assessment of left ventricular function using pulsed tissue Doppler imaging in healthy dogs and dogs with spontaneous mitral regurgitation

Pulsed tissue Doppler imaging (pulsed TDI) has been demonstrated to be useful for the estimation of left ventricular (LV) systolic and diastolic functions in various human cardiac diseases. The objectives of this study were to investigate the relationship between pulsed TDI and LV function by using cardiac catheterization in healthy dogs and to evaluate the clinical usefulness of pulsed TDI in dogs with spontaneous mitral regurgitation (MR). The peak early diastolic velocity (E'), peak atrial systolic velocity (A'), and peak systolic velocity (S') were detectable in the velocity profiles of the mitral annulus in all the dogs. In the healthy dogs, S' and E' were correlated with LV peak +dP/dt and -dP/dt, respectively. E' was lower in dogs with MR than in dogs without cardiac diseases. E/E' in the MR dogs with decompensated heart failure was significantly increased in comparison with those with compensated heart failure. The sensitivity and specificity of the E/E' cutoff value of 13.0 for identifying decompensated heart failure were 80% and 83%, respectively. In addition, E/E' was significantly correlated with the ratio of left atrial to aortic diameter. These findings suggest that canine pulsed TDI can be applied clinically for estimation of cardiac function and detection of cardiac decompensation and left atrial volume overload in dogs with MR.