Page 17 - VetCPD Jnl Volume 7, Issue 4

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1) Based on current clinical evidence, which of the following combination
of anti-arrhythmics is considered the most appropriate at reducing the heart rate in dogs with AF?
A) Amiodarone and sotalol
B) Diltiazem and amiodarone
C) Sotalol and digoxin
D) Diltiazem and digoxin
2) An ECG diagnosis of atrial fibrillation requires which of the following:
A) Regular R-R interval
B) Absence of P waves
C) A heart rate of >180bpm
D) ST elevation
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adequate rate control (Gelzer et al. 2009 ). A more recent study showed that an in-clinic ECG-derived HR<160 bpm was associated with longer survival times than
a HR>160 bpm. (Jung et al. 2016). It is widely accepted that fast ventricular rates predispose to significant remodelling (tach- ycardia induced cardiomyopathy) (Morillo et al. 1995), 140 or 160 bpm may be too high a cut-off, in particular if we consider that the normal mean HR based on a 24-hours-Holter in healthy dogs varies between 70-80 bpm (Lamb et al. 2010).
VETcpd - Cardiology
it has also been shown to improve the survival time of dogs with AF (Vollmar and Fox, 2016). Use of this drug and an appropriate HR control may be the best strategies for dogs with AF currently.
Conclusion
AF is the most common non-physiologic arrhythmia in dogs and therefore it is crucial for the general practitioner to understand how to monitor and treat it. Managing AF patients can be challenging, in particular as clear guidelines are missing. However, managing dogs with AF can also be rewarding, as an improvement of the patients’ clinical signs is frequently seen after starting appropriate treatment. Rate control and rhythm control are the two main treatment strategies, but rate control is the most commonly used approach in dogs. Close monitoring of the arrhythmia and concurrent underlying heart disease are essential to maximize quality of life.
A more recent retrospective study used 24-hour-Holter monitoring to investigate the ideal HR to aim for in dogs with AF. It showed that dogs with a 24-hour Holter derived mean HR <125 bpm had a longer survival time than dogs with >125 bpm (1037 vs 105 days) (Pedro et al. 2018). Based on the current evidence base, clini- cians should aim for <125bpm to improve long term outcome, however prospective studies are currently taking place to further
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Dogs with lone AF have the longest www.vetcpd.co.uk/references www.vetcpd.co.uk/subscribe survival, especially when compared
with dogs in AF and concurrent CHF
KEY LEARNING POINTS
APPROA
(40 months vs 5 months, respectively) (Menaut et al. 2005). In fact, the presence of CHF was associated with a hazard ratio of 1.44 (Westling et al. 2008) and appears to have a more significant impact than the presence of AF itself on survival time: Irish Wolfhounds with DCM and sinus rhythm had similar median survival times to dogs with DCM and AF, but both these groups
CH TO
SMALL ANIMAL
• Atrial fibrillation is the most common pathological arrhythmia encountered in dogs
CARDIOLOGY
• Atrial fibrillation requires an ECG ly
8 HOURS CPD
TUTORED BY
JESSIE ROSE PAYNE
BVetMed MVetMed PhD MRCVS,
DipACVIM (Cardiology), American Specialist in Veterinary Cardiology
£149 + VAT
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Vet nurses very welcome
From the incidentally detected murmur in
a young puppy, to the dogs with a history of collapsing episodes, to the cat that presents in respiratory distress, cardiovascular disease is frequently encountered. This course provides
a framework for an approach to a variety of clinical scenarios, discusses likely differentials and the next steps for diagnosis and management in first opinion practice.
This course explores the following topics:
• Module 1 & 2: Approach to the murmur in the apparently healthy dog • Module 3: Approach to the murmur in the apparently healthy cat • Module 4: Approach to arrhythmias • Module
5: Approach to the collapsing patient • Module 6: Approach to the acute cardiology patient • Module 7:Treatment of canine cardiac disease • Module 8:Treatment of feline cardiac disease
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• Most cases of atrial fibrillation are a result of underlying structural disease such as dilated cardiomyopathy and mitral valve disease
me than dogs in AF with DCM and CHF
(Vollmar et al. 2019b).
Many studies report varying results of survival analysis, and the data is not directly comparable as different background populations have been analysed. For example,AF did reduce survival time
in Dobermanns with DCM and CHF: dogs with AF showed a greater than 50% mortality during the first two weeks (Calvert et al. 1997). Additionally, in dogs with MDVD, development of AF reduces the survival time (234 days without AF vs 142 days with AF) and increases the risk of cardiac-related death (Jung et al. 2016). On the other hand, in a population of dogs with DCM, only ventricular arrhythmias were negatively associated with survival time in the final multivariate analysis (Martin et al. 2010).
In addition, the widespread use of pimobendan has not only altered the standard of care of patients in CHF, but
had a significant
ly longer survival ti
for definitive diagnosis
• Optimal control of atrial
fibrillation requires appropriate
management of CHF if present • Medical management of AF is
appropriate for all cases, including lone AF, where the heart rate is fast, or if there are signs of poor cardiac output
• Electrical cardioversion of AF back to a sinus rhythm is possible but appropriate only where
there is no significant underlying disease, or rarely if AF cannot
be controlled well with medical management in the presence of structural heart disease
• A combination of diltiazem and digoxin is currently considered the best therapy for managing atrial fibrillation in dogs
• Maintaining a mean “home” heart rate of <125bpm is associated with improved survival
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