Orthodromic Atrioventricular Reentry Bradycardia and Tachycardia Caused by an Accessory Pathway in Horses.

Abstract

BACKGROUND: Accessory pathways (APs) are muscular bundles directly connecting the atria and ventricles, bypassing the atrioventricular (AV) node-His-Purkinje system. Anterograde conduction along the AP results in ventricular preexcitation. A retrograde conducting AP allows ventriculo-atrial (VA) conduction, creating a reentry circuit that mediates orthodromic atrioventricular reentry tachycardia (OAVRT). This condition is well described in humans and small animals, but has not been reported previously in horses. OBJECTIVES: Describe clinical and electrocardiographic findings of horses with retrograde AP conduction and reporte mapping and radiofrequency ablation results in one horse. ANIMALS: Six horses with retrograde AP conduction. METHODS: Records from six horses with retrograde AP conduction were reviewed. RESULTS: Resting ECGs showed P' waves in the ST segment with fixed coupling intervals to the preceding QRS complexes. In five of six horses, P' waves were conducted back to the ventricles along the AV node, resulting in OAVRT. All horses had episodes where P' waves were blocked at the AV node, which resulted in orthodromic atrioventricular reentry bradycardia (OAVRB). In one horse, the AP conducted bidirectionally resulting in ventricular preexcitation. An electrophysiological study in one horse identified a left-atrial AP insertion by the shortest VA interval. Radiofrequency ablation using an impedance-based mapping system could not eliminate the AP. CONCLUSIONS: Retrograde conducting APs in horses caused OAVRT and OAVRB. APs in horses behaved differently compared to those in humans and dogs. Further research is necessary to elucidate AP behavior, evaluate risk and effect on performance, and assess treatment by ablation.