Practices and outcome of artificial cardiac pacing in 154 dogs

Artificial pacing (AP) is a treatment for symptomatic bradyarrhythmias unresponsive to medical therapy. This retrospective study was designed to define the practices and outcome of AP in dogs at 7 referral institutions participating in the Companion Animal Pacemaker Registry and Repository (CANPACERS). The indications, implantation techniques, complications, long-term outcome, and owner satisfaction were examined. One hundred fifty-four dogs were identified as undergoing AP from January 1, 1991, to January 1, 1996. Third-degree atrioventricular (AV) block (n = 91; 59%) and sinus node dysfunction (n = 45; 29%) were the most common indications for AP Transvenous endocardial AP systems were implanted in 136 dogs (88%), and epicardial systems were implanted in 18 (12%). Complications associated with AP were reported in 84 dogs (55%). Major complications occurred in 51 dogs (33%), including dislodgement of the pacing lead (n = 15; 10%), generator failure (n = 10; 6%), cardiac arrest during implantation (n = 9; 6%), and infection (n = 7; 5%). Minor complications occurred in 47 dogs (31%), including seroma formation (n = 18; 12%), muscle twitch (n = 17; 11%), and inconsequential arrhythmias (n = 15; 10%). Fourteen dogs (9%) experienced both major and minor complications. Survival analysis revealed 1-, 2-, and 3-year survival rates of 70, 57, and 45%, respectively. Age and presence of preexisting congestive heart failure (CHF) had a negative effect on survival (P = .001). Sixty percent of dogs with preexisting CHF died within 1 year of implantation, whereas 25% of dogs without heart failure died during the same period. Owners rated their satisfaction with the procedure as high in 80% of the dogs.     

Cardiovascular device infections in dogs: report of 8 cases and review of the literature

BACKGROUND: Infection is an infrequent but major complication of cardiovascular device implantation. HYPOTHESIS: Treatment of patients with cardiovascular implant infection with antibiotic therapy and removal of the device is superior to antibiotic therapy alone. METHODS: Medical records were reviewed for dogs that received a cardiovascular device from June 2001 to August 2006 at the University of Minnesota Veterinary Medical Center and the University of Missouri Veterinary Medical Teaching Hospital. RESULTS: Six of 63 (9.5%) pacemaker systems and 2 of 47 (4.3%) patent ductus arteriosus (PDA) occlusion devices became infected. Median time from procedure to diagnosis of implant infection was 62 days (range, 5 to 419). Median age of dogs with pacemaker infections was 8.5 years (range, 6.2 to 11.9). Pseudomonas aeruginosa and Staphylococcus spp were the most commonly cultured isolates. Four dogs were treated with antibiotics and pacemaker replacement. All 4 recovered completely from their infections. One was alive at the end of the study period, and 3 had been euthanized. However, the reasons for euthanasia were unrelated to pacemaker infection. In contrast, both dogs with infected pacemakers that were treated with antibiotics alone were euthanized because of complications attributable to infection. Infection of PDA occlusion devices occurred in puppies < 16 weeks of age, and Pasteurella spp were isolated from both. One was successfully treated with a combination of antibiotics and surgery, and the other was euthanized without treatment. CONCLUSIONS AND CLINICAL IMPORTANCE: Antibiotic therapy alone is associated with chronic complications in patients with cardiovascular implants and is unlikely to effect a cure.     

Atrial and Ventricular Electrical and Contractile Remodeling and Reverse Remodeling Owing to Short‐Term Pacing‐Induced Atrial Fibrillation in Horses

Background: In humans, atrial fibrillation (AF) induces electrical, contractile, and structural remodeling leading to AF stabilization. Little is known about AF‐induced atrial remodeling in horses. Hypothesis: Induced AF produces rapid atrial electrical and contractile remodeling in horses. Animals: Six horses, 5 animals completed the study. Methods: Each horse was instrumented with a pulse generator and pacemaker to maintain AF by burst pacing and to study atrial and ventricular electrophysiology (AF cycle length [AFCL], AF duration, and atrial/ventricular effective refractory period [AERP/VERP] at different pacing cycle lengths [PCL]). Left atrial and ventricular contractile remodeling were assessed echocardiographically by calculation of fractional changes in atrial and ventricular dimensions, respectively, during the cardiac cycle. Measurements were performed at baseline, a 7‐day AF period and a 2‐day recovery period. Results: Atrial electrical and contractile remodeling could be demonstrated after 4 and 12 hours of AF, respectively. A progressive shortening of the AERP (261 ± 39–171 ± 18 ms at a PCL of 1,000 ms, P < .0001), an attenuation of the AERP rate adaptation, a decrease in AFCL (239 ± 39–194 ± 7 ms, P < .0001), and a decrease in atrial FS (12 ± 3% to 0 ± 2%, P < .05) occurred. AF duration increased progressively and became persistent in 2 animals. VERP did not change significantly. Upon restoration of sinus rhythm, values returned to baseline within 48 hours. Conclusions and Clinical Importance: Atrial electrical and contractile remodeling appears rapidly. After 7 days of AF, reverse remodeling occurred within 2 days. These observations suggest that early conversion of AF might be beneficial for success rate and early return to training.     

Secure pacemaker fixation critical for prevention of Twiddler's syndrome

A two year old, female spayed border collie presented three weeks after permanent pacemaker implantation for weakness, lethargy and collapse. Electrocardiogram documented complete (3^rd degree) atrioventricular (AV) block, the absence of pacing and a ventricular escape rhythm. Thoracic radiographs revealed retraction and dislodgement of the passive fixation lead from the right ventricular apex. During a procedure to reposition the lead, it was noted that lead retraction had resulted from rotation of the generator with twisting and entanglement of the lead on itself and around the generator, a complication recognized in human patients as “Twiddlers syndrome”. The pacemaker lead was removed, a new lead securely placed at the right ventricular apex, and the generator was secured into a revised subcutaneous pocket. Pacing was re-established and the Twiddler's syndrome has not reoccurred.     

Noninvasive transthoracic temporary cardiac pacing in dogs

Temporary cardiac pacing is used in the emergency treatment of life-threatening bradyarrhythmias and for the support of heart rate and blood pressure of patients with sick sinus syndrome or high-grade atrioventricular (AV) block undergoing general anesthesia, typically for permanent pacemaker implantation. We retrospectively evaluated the safety and efficacy of a noninvasive transthoracic external cardiac pacing system in 42 dogs treated for bradyarrhythmias. Optimal placement of the patch electrodes on the skin of the thorax was initially established on 2 anesthetized normal dogs. The optimal electrode placement was determined to be on the right and left hemithoraces, directly over the heart. Afterward, by means of this electrode placement all 42 dogs treated for bradyarrhythmias in this study were successfully paced with the noninvasive transthoracic system. Dogs ranged in age from 1 to 15 years and weighed between 3.2 and 40 kg. Miniature Schnauzers, German Shepherds, and mixed breeds were most common in the study population. Indications for noninvasive transthoracic pacing included emergency treatment of hemodynamically unstable 3rd-degree AV block (2 dogs): support of heart rate during general anesthesia for permanent pacemaker implantation or lead-wire adjustment (38 dogs): and support of heart rate during general anesthesia for ophthalmologic surgery in dogs with sick sinus syndrome (2 dogs). Complications included pain and skeletal muscle stimulation, which required general anesthesia. We conclude that the noninvasive transthoracic pacing system evaluated is satisfactory for clinical veterinary use.     

Characteristics of pacemaker current in aged rat atrial myocytes

AIM: To investigate the characteristics of pacemker current (I_f) of atrium myocytes in aged rats. METHODS: Aged SD rats (22-24 months) were used in the study. The single atrium myocytes were isolated. I_f current was recorded by the technique of whole-cell patch clamp. RESULTS: The densities of I_f increased markedly in aged rat atrium myocytes compared with that in the cells of young rats. At the test potential of-150 mV, the average amplitude of I_f was (382±23)pA and the current density was (3.2±0.4)pA/pF, while the average amplitude of I_f in control group was (86.9±8.4)pA and the current density was (0.9±0.1)pA/pF,P<0.01. I_f current was augmented at negative hyperpolarzing test potential. Time constants of activation in aged and control cells were (230.2±14.4)ms and (670.5±23.6)ms, respectively. Furthermore, steady state curves in the elder cells was shifted to positive potentials and the voltages for half maximal activation were (-87.2±2.3)mV (aged cells) and (-104.4±6.3)mV (control cells). In contrast, the slope of activation curves and reversed potential of I_f were slightly different between aged cells and control cells. CONCLUSION: The amplitude and densities of I_f in atrium cells of aged rats were larger than that of control rats.     

Transvenous pacemaker placement in a dog with atrioventricular block and persistent left cranial vena cava

The case reported herein describes the placement of a permanent transvenous pacemaker in an older dog with a previously undiagnosed persistent left cranial vena cava (PLCVC) and recent onset symptomatic third-degree atrioventricular (AV) block. On presentation the dog was found to have atrial flutter and third-degree AV block and echocardiography demonstrated evidence of chronic valvular disease and pulmonary arterial hypertension. The persistent left cranial vena cava was discovered via angiography when difficulties were encountered with pacemaker placement. Successful right ventricular pacing necessitated passage of the lead through the coronary sinus. The attendant complications in pacemaker placement in the presence of a PLCVC are well-described in man but, to the authors' knowledge, have not been described in companion animals.     

Follow-up of troponin I concentration in dogs with atrioventricular block and dual-chamber pacing in a case-matched study

Background

Increased cardiac troponin I (cTnI) concentration has been reported in dogs with atrioventricular (AV) block before and shortly following pacemaker implantation. The role of AV dyssynchrony, age, or concurrent cardiac disease on cTnI concentration remains unknown.