Evaluation of shock waveform configuration on the defibrillation capacity of implantable cardioverter defibrillators in dogs

BackgroundImplantable cardioverter defibrillators (ICD) are programmed to detect ventricular arrhythmias and terminate them by delivering an electrical shock. A defibrillation threshold (DFT) at least 10 J below the maximum device output is recommended for successful therapy. Shock waveform configuration is a programmable parameter used to achieve a low DFT. It is hypothesized that a fixed-pulse configuration results in lower defibrillation energy requirements than a fixed-tilt configuration.Animals10 mongrel dogs.Materials and methodsICD generator and transvenous lead were surgically implanted. Defibrillation threshold was determined using a protocol guided by the upper limit of vulnerability. Fixed-pulse and fixed-tilt (50%/50%) waveform configurations were tested in a random order. Plasma cardiac troponin I (cTnI) was measured for signs of myocardial injury.ResultsThe experiment was completed in 9 dogs. Overall mean DFT value was 424 ± 88 V (9.2 ± 3.9 J). Mean differences among voltage, energy and impedance at the DFT for fixed-pulse (422 ± 97 V, 9.1 ± 4.2 J, 62.6 ± 13.8 Ω) and fixed-tilt (426 ± 83 V, 9.3 ± 3.8 J, 62.8 ± 18.5 Ω) configurations were not statistically significant (All P > 0.21). Cardiac TnI concentration changed from 0.03 ng/mL (95% CI: 0.02–0.04) at baseline to 0.11 ng/mL (95 CI: 0.08–0.16) after DFT was obtained with the first waveform configuration and 0.19 ng/mL (95% CI: 0.13–0.28) at the end of the study period. There were no significant changes in heart rate, end-tidal CO2 and blood pressure over time (all P > 0.09).ConclusionThe tested ICD device and lead placement reliably produced acceptable DFT values, based on a 10-J safety margin below the maximum device output. A benefit of fixed-pulse configuration could not be demonstrated over the standard fixed-tilt waveform. Signs of acute myocardial damage from repeated high-voltage shocks and episodes of ventricular fibrillation seemed of limited clinical significance.     

Hemodynamic alterations in dogs with shock induced by intravenous injection of heartworm extract

To elucidate one way of the shock mechanisms, the hemodynamic alterations were examined in 7 dogs with heartworm (HW) extract-induced shock. The first alteration observed after injection of HW extract was a decrease in right ventricular end-diastolic pressure (RVEDP). After that, left ventricular (LV) end-diastolic pressure, LV systolic pressure, and LV dp/dt fell significantly, followed by a decrease in the cardiac output of all dogs to below the detectable level (1.00 l/min). Since RVEDP depends on blood flow into the right ventricle, the decrease in RVEDP means a reduction in venous return. Therefore, this study showed that the first trigger of a decrease in blood pressure in HW extract-induced shock is the reduction in venous return.     

Osmolal and anion gaps in dogs with acute endotoxic shock

Serum osmolalities, biochemical concentrations, osmolal and anion gaps, blood lactate concentrations, and acid base status were evaluated in anesthetized, healthy control dogs and in dogs with endotoxic shock. The osmolal gap was not affected by endotoxemia. Compared with control dogs, dogs with endotoxic shock had mildly, though insignificantly, increased anion gaps and significantly increased blood lactate concentrations. The anion gap in dogs with endotoxic shock was positively (r = 0.77) and significantly correlated with the blood lactate concentration. Therefore, the blood lactate concentration of a dog in endotoxic shock may be estimated by use of the equation: lactate = 0.27 (anion gap) - 1.46. Confidence limits for this estimation were calculated. Dogs with endotoxic shock developed a lactic acidosis and hyperchloremic metabolic acidosis, with hyperventilation.     

水飞蓟宾对镉致小鼠急性肝损伤的保护作用

探讨水飞蓟宾对镉致小鼠急性肝损伤的保护作用及其机制。将30只小鼠随机分成3组:正常对照组、镉组、水飞蓟宾干预组。正常对照组、镉组小鼠每日灌胃1%羧甲基纤维素钠悬混液,水飞蓟宾干预组小鼠经口给予100 mg·kg~(-1)水飞蓟宾,每日灌胃1次,连续灌胃7 d,于最后一次灌胃后1 h,正常对照组小鼠腹腔注射生理盐水0.01 mL·g~(-1),镉组及水飞蓟宾干预组小鼠一次性腹腔注射4 mg·kg~(-1)氯化镉,24 h后摘小鼠眼球取血,处死小鼠。检测血清丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)活性;制作肝组织切片,H.E染色,观察各组小鼠肝组织形态学变化;免疫组化检测肝组织HSP70蛋白表达;肝组织匀浆液检测一氧化氮(NO)含量及髓过氧化物酶(MPO)活性。结果显示,镉组小鼠血清ALT和AST活性与正常对照组比较显著升高,肝细胞出现变性、坏死,水飞蓟宾干预组小鼠血清ALT和AST活性与镉组比较显著降低,同时,肝细胞变性、坏死明显减轻;免疫组化检测结果显示,镉组小鼠肝组织热应激蛋白(HSP70)表达与正常对照组比较显著降低(P0.05),而水飞蓟宾干预组小鼠肝细胞HSP70蛋白表达与镉组比较均极显著升高(P0.01);与正常对照组比较,染镉组小鼠肝组织一氧化氮(NO)含量及髓过氧化物酶(MPO)活性均极显著升高(P0.01),水飞蓟宾干预组小鼠与镉组小鼠比较,肝组织NO含量和MPO活性极显著降低(P0.01)。结果表明,水飞蓟宾能减轻镉毒性导致的小鼠肝组织细胞急性损伤,其机制可能与水飞蓟宾降低NO含量及MPO活性,促进染镉小鼠肝组织细胞HSP70蛋白表达有关。     

Cardiac troponins as indicators of acute myocardial damage in dogs

Cardiac troponin I (cTnI) and T (cTnT) have a high sequence homology across phyla and are sensitive and specific markers of myocardial damage. The purpose of this study was to evaluate the Cardiac Reader, a human point-of-care system for the determination of cTnT and myoglobin, and the Abbott Axsym System for the determination of cTnI and creatine kinase isoenzyme MB (CK-MB) in healthy dogs and in dogs at risk for acute myocardial damage because of gastric dilatation-volvulus (GDV) and blunt chest trauma (BCT). In healthy dogs (n = 56), cTnI was below detection limits (<0.1 microg/L) in 35 of 56 dogs (reference range 0-0.7 microg/L), and cTnT was not measurable (<0.05 ng/mL) in all but 1 dog. At presentation, cTnI, CK-MB, myoglobin, and lactic acid were all significantly higher in dogs with GDV (n = 28) and BCT (n = 8) than in control dogs (P < .001), but cTnT was significantly higher only in dogs with BCT (P = .033). Increased cTnI or cTnT values were found in 26 of 28 (highest values 1.1-369 microg/L) and 16 of 28 dogs (0.1-1.7 ng/mL) with GDV, and in 6 of 8 (2.3-82.4 microg/L) and 3 of 8 dogs (0.1-0.29 ng/mL) with BCT, respectively. In dogs suffering from GDV, cTnI and cTnT increased further within the first 48 hours (P < .001). Increased cardiac troponins suggestive of myocardial damage occurred in 93% of dogs with GDV and 75% with BCT. cTnI appeared more sensitive, but cTnT may be a negative prognostic indicator in GDV. Both systems tested seemed applicable for the measurement of canine cardiac troponins, with the Cardiac Reader particularly suitable for use in emergency settings.     

Effects of atropine, isoprenaline, neostigmine and practocol on cardiac arrhythmias induced by potassium in anesthetized dogs

Either atropine, isoprenaline, neostigmine or practolol was given intravenously in therapeutic doses to dogs anesthetized with pentobarbitone sodium. Cardiac arrhythmias were induced by potassium chloride intravenously as a bolus injection in a dose of 0.3 mmol/kg. The standard electrocardiographic lead II was recorded continuously. pH, Po2 and Pco2 were checked from arterial blood samples before and after the injection. The isoprenaline treated dogs showed the smallest amount of arrhythmias and all the dogs survived. More severe arrhythmias were seen in the neostigmine and practolol treated dogs and the most severe occurrences were encountered in the atropine treated dogs.     

Effect of benazepril on survival and cardiac events in dogs with asymptomatic mitral valve disease: a retrospective study of 141 cases

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) improve quality of life and extend the life span of dogs with naturally acquired ISACHC class II-III congestive heart failure (CHF). However, their effects on asymptomatic heart disease remain controversial. HYPOTHESIS: Benazepril (BNZ), an ACEI, could have beneficial effects at the asymptomatic stage of degenerative mitral valve disease (MVD). ANIMALS: Dogs with ISACHC class Ia MVD and moderate-to-severe mitral regurgitation (MR) assessed by the color Doppler mapping technique at entry (Day 0) were retrospectively included. METHODS: Dogs were assigned to the treated group (BNZ group) if they received BNZ (and no other cardiac medication) from Day 0 or to the untreated group (UT group) if they did not receive any cardioactive treatment until occurrence of CHF. RESULTS: A total of 141 dogs were included in the study, 66 in the BNZ group (dosage: 0.30 +/- 0.13 mg/kg) and 75 in the UT group. In the population (n = 93) including all breeds except Cavalier (CKC) and King Charles Spaniels (KC), median survival time to all causes of death in the BNZ group (n = 34, 3.3 years) was significantly longer than in the UT group (n = 59, 1.9 years) as was time to cardiac event (P < .05). Conversely, no effect of the BNZ treatment was observed in the CKC and KC population. CONCLUSIONS AND CLINICAL RELEVANCE: BNZ had beneficial effects in asymptomatic dogs other than CKC and KC affected by MVD with moderate-to-severe MR. Breed distribution should be taken into account for interpretation of clinical trials performed in dogs with cardiac disease.     

Effects of lactated Ringer solution and prednisolone sodium succinate on dogs with induced hemorrhagic shock.

Hemorrhagic shock was induced in nonsplenectomized dogs by removing 41% of their blood volume over a 15-minute period. Hemodynamic and metabolic variables were determined prior to and for 3 hours after completion of hemorrhage. One group of 5 dogs was not treated. After the 30-minute sample was collected, a second group of 5 dogs was given lactated Ringer solution (LRS) at 88 ml/kg of body weight, IV. A third group of 5 dogs was given LRS (88 ml/kg, IV) and prednisolone sodium succinate (11 mg/kg, IV) 30 minutes after hemorrhage. The IV administration of LRS was completed within 15 minutes. The glucocorticoid was administered as an IV bolus after 500 ml of LRS had been given. The large volume and administration of LRS significantly (P = 0.05) improved many of the hemodynamic and metabolic effects of acute hemorrhage and hemorrhagic shock. At one time or another during the 2.5-hour observation period after the initiation of treatment, mean arterial pressure, cardiac index, systemic vascular resistance, heart rate, respiratory rate, lactate, glucose, and arterial and venous blood gas values were significantly (P = 0.05) improved, compared with baseline values. The addition of prednisolone sodium succinate to the treatment regimen improved the effectiveness of LRS alone only in some dogs at random sampling times. Significant trends were not observed except, possibly, the improvement of venous pH and A-V pH and PCO2 differences.     

Effect of spaying and timing of spaying on survival of dogs with mammary carcinoma

The risk of developing mammary gland tumors in dogs is significantly decreased by ovariohysterectomy at an early age. However, previous studies have not found a benefit to ovariohysterectomy concurrent with tumor removal in dogs with established mammary gland tumors, suggesting that the progression of these tumors is independent of continued estrogen stimulation. The purpose of this study was to evaluate the effect of spaying and of the timing of spaying on survival in dogs with mammary gland carcinoma. Signalment, spay status and spay age, tumor characteristics, treatment. survival, and cause of death of 137 dogs with mammary gland carcinoma were analyzed. The dogs were classified into 3 groups according to spay status and spay time: intact dogs, dogs spayed less than 2 years before tumor surgery (SPAY 1), and dogs spayed more than 2 years before their tumor surgery (SPAY 2). Dogs in the SPAY 1 group lived significantly longer than dogs in SPAY 2 and intact dogs (median survival of 755 days, versus 301 and 286 days, respectively, P = .02 and .03). After adjusting for differences between the spay groups with regard to age, histologic differentiation, and vascular invasion, SPAY 1 dogs survived 45% longer compared to dogs that were either intact or in the SPAY 2 group (RR = .55; 95% CI .32-.93; P = .03). This study reveals ovariohysterectomy to be an effective adjunct to tumor removal in dogs with mammary gland carcinoma and that the timing of ovariohysterectomy is important in influencing survival.     

Effect of carprofen, etodolac, meloxicam, or butorphanol in dogs with induced acute synovitis

OBJECTIVE: To compare the analgesic and anti-inflammatory effect of single doses of carprofen, etodolac, meloxicam, and butorphanol in dogs with induced acute synovitis (acute pain model) via kinetic gait analysis and orthopedic evaluation and examine measurement of serum C-reactive protein (CRP) concentration as an indicator of treatment efficacy. ANIMALS: 12 Beagles and 6 additional Beagles that were used only in serum CRP analyses. PROCEDURE: Acute synovitis was induced in right stifle joints of dogs via intra-articular injection of monosodium urate solution. Treatments included butorphanol (0.2 mg/kg, i.v.), carprofen (4 mg/kg, PO), etodolac (17 mg/kg, PO), or meloxicam (0.2 mg/kg, PO); control dogs received no treatment. The procedure was repeated (3-week intervals) until all dogs received all treatments including control treatment. Lameness was assessed on a biomechanical force platform and via orthopedic evaluations of the stifle joints; blood was collected to monitor serum CRP concentration. RESULTS: Compared with control dogs, treated dogs had significantly different vertical ground reaction forces and weight-bearing scores. Greatest improvement in lameness was observed in carprofen-treated dogs. Etodolac had the fastest onset of action. Compared with butorphanol treatment, only carprofen and etodolac were associated with significantly lower pain scores. An increase in serum CRP concentration was detected after intra-articular injection in all dogs; this change was similar among groups. CONCLUSIONS AND CLINICAL RELEVANCE: Carprofen, etodolac, and meloxicam had greater efficacy than butorphanol in relief of acute pain. Carprofen was most effective overall. In this acute pain model, serum CRP analysis was not useful to assess drug efficacy.     

Myocardial damage in dogs affected by heartworm disease (Dirofilaria immitis): Immunohistochemical study of cardiac myoglobin and troponin I in naturally infected dogs

It has recently been reported that dogs affected by canine heartworm disease (Dirofilaria immitis) can show an increase in plasma levels of myoglobin and cardiac troponin I, two markers of muscle/myocardial injury. In order to determine if this increase is due to myocardial damage, the right ventricle of 24 naturally infected dogs was examined by routine histology and immunohistochemistry with anti-myoglobin and anti-cardiac troponin I antibodies. Microscopic lesions included necrosis and myocyte vacuolization, and were associated with loss of staining for one or both proteins. Results confirm that increased levels of myoglobin and cardiac troponin I are indicative of myocardial damage in dogs affected by heartworm disease.     

Serum amylase and isoamylases and their origins in healthy dogs and dogs with experimentally induced acute pancreatitis

Agarose-gel electrophoresis was used to study isoamylases in tissues and sera of healthy dogs and the sera of dogs with experimentally induced acute pancreatitis. Three or 4 isoamylases were found in the serum of healthy dogs; they were numbered 1 to 4 with respect to their degree of anodal migration. Peak 4 isoamylase, the slowest migrating (most cathodal), was the major isoamylase fraction in sera and tissues of healthy dogs. Peak 3 was identified as a pancreas-specific isoamylase. Absolute total serum amylase and total isoamylase concentrations increased significantly in dogs with pancreatitis compared with values for control dogs (sham-operated). The relative increase in peak 3 isoamylase was greater than that seen with total amylase or the other isoamylases. The decrease in total serum amylase and isoamylase concentrations paralleled each other; however, peak 3 remained proportionally high longer than did total amylase and the other isoamylase fractions. These findings indicate that measurement of peak 3 isoamylase concentrations may be of diagnostic value in dogs with suspected pancreatitis with normoamylasemia and in dogs with extrapancreatic hyperamylasemia.     

Effect of routine cardiovascular catheterization on cardiac troponin I concentration in dogs

ObjectiveTo determine changes in cardiac troponin I concentration (cTnI) associated with cardiovascular catheterization in dogs.Animals, materials and methodscTnI was measured after transarterial coil embolization of patent ductus arteriosus (PDA), balloon valvuloplasty (BV), and pacemaker implantation (PACE). Dogs undergoing ovariohysterectomy (OHE) were used as a control, with 15 animals in each group. Blood for the cTnI assay was collected at baseline (T0), at 5 h (T5), 24 h (T24) and 10 days (T240) post-procedure. The effects of age, duration and difficulty of the procedure were evaluated.ResultsThere was no difference in cTnI concentration at T0 for any of the groups. There was a significant increase in cTnI concentration for BV and PACE, but not PDA at T5 and T24. PACE at T24 and T240 also had higher cTnI than control. Dogs with longer procedure times had significantly higher concentration of cTnI. There was no correlation between the difficulty of the procedure or peri-procedure complications and cTnI.ConclusioncTnI increased during some cardiovascular catheterization procedures, but returned to normal values at 24–240 h. Patients undergoing long catheterization procedures have increased risk for myocardial injury, but this was not related to short-term prognosis.     

The efficacy and safety of external biphasic defibrillation in toy breed dogs

Objective: To evaluate the efficacy and safety of biphasic (BP) defibrillation in toy breed dogs (<5 kg of body weight).
Design: Prospective, clinical experimental study.
Setting: Veterinary teaching hospital.
Animals: Five dogs (pilot study) and 10 dogs (comparison study of biphasic versus monophasic defibrillation).
Measurements and main results: The efficacy of defibrillation was compared by estimating E80 (80% probability of successful defibrillation) after biphasic (BP) and monophasic (MP) defibrillations. The E80 for BP defibrillation was 7.24±1.33 J (2.24±0.41 J/kg) and 10.24±1.34 J (3.18±0.12 J/kg) for MP defibrillation. BP waveform required 30% less shock energy for a successful defibrillation. In order to compare the safety of defibrillation, we evaluated changes in cardiac biomarkers, electrocardiogram, echocardiographical left ventricular index, and aortic pressure during and after BP and MP defibrillation. All dogs treated by either BP or MP defibrillation survived. Pulseless electrical activity occurred in 2 of 5 dogs during MP defibrillation. The levels of cardiac biomarkers were elevated and sustained for longer periods in the MP defibrillation group. Electrocardiographic changes (e.g., QT prolongation, the time to return to an isoelectric ST segment after shocks) were more severe and longer in the MP defibrillation group. In addition, overall left ventricular cardiac performance was severely depressed in the MP group compared with the BP group.
Conclusion: Our findings suggest that BP defibrillation is more effective and safer than MP defibrillation. We determined the acceptable shock energy to be 2–4 J/kg for toy breed dogs.     

Use of laparoscopy for diagnosing experimentally induced acute pancreatitis in dogs

Diagnosis of acute pancreatitis in dogs remains a significant challenge despite the development of advanced diagnostic methodologies. Visual inspection and pancreas biopsy using laparoscopy are generally considered to be procedures free of complications when conducted on healthy animals. However, the usefulness of laparoscopy for diagnosing acute pancreatitis has not been assessed. In the present study, the efficacy of laparoscopy for diagnosing acute pancreatitis in dogs was evaluated in animals with experimentally induced acute pancreatitis. Gross appearance of the pancreatic area was examined by laparoscopy to survey for the presence of edema, adhesions, effusion, pseudocysts, hemorrhage, and fat necrosis. Laparoscopic biopsy was performed and the histopathologic results were compared to those of pancreatic samples obtained during necropsy. The correlation between laparoscopy and histopathologic findings of the pancreas was evaluated. The presence of adhesions, effusion, and hemorrhage in the pancreatic area observed by laparoscopy significantly correlated with the histopathologic results (p < 0.05). There was no significant relationship between the histopathologic and laparoscopic biopsy findings. Results of this study suggested that laparoscopic evaluation of gross lesions has clinical significance although the laparoscopic biopsy technique has some limitations. This method combined with additional diagnostic tools can be effective for diagnosing acute pancreatitis in dogs.