Twenty-four hour continuous transvenous temporary right ventricular pacing in healthy horses.

Abstract

BACKGROUND: The ability to perform transvenous temporary cardiac pacing (TV-TP) is critical to stabilize horses with symptomatic bradyarrhythmias. Reports of successful TV-TP in horses are limited, and only briefly describe short-term pacing. OBJECTIVE: To describe temporary, medium-term (24&#x2009;h) transvenous right ventricular pacing in awake horses using a bipolar torque-directed pacing catheter. ANIMALS: Six healthy adult institutional teaching horses. METHODS: Prospective experimental study with 2 immediately successive TV-TP lead placements in each horse with a target location of the RV apex. One placement was performed primarily with echocardiographic guidance and 1 primarily with fluoroscopic guidance. In all placements, corresponding images were obtained with both imaging modalities. Horses were then paced for 24&#x2009;h, unrestricted in a stall with continuous telemetric ECG monitoring. Echocardiographically determined lead position, episodes of pacing failure in the preceding 6&#x2009;h, and pacing thresholds were recorded every 6&#x2009;h. Pacing failure was defined as a period of loss of capture longer than 20&#x2009;s. RESULTS: Pacing leads were placed with both guidance methods and maintained for 24&#x2009;h with no complications. Two horses with leads angled caudally in the right ventricular apex had no pacing failure, the remaining 4 horses had varying degrees of loss of capture. Leads located in the right ventricular apex had longer time to pacing failure and lower capture thresholds P&#x2009;<&#x2009;0.05. CONCLUSIONS AND CLINICAL IMPORTANCE: Medium-term TV-TP is feasible and has potential for stabilization of horses with symptomatic bradyarrhythmias. Lead position in the right ventricular apex appears optimal. Continuous ECG monitoring is recommended to detect pacing failure.