Intracardiac ultrasound-guided transseptal puncture in horses: Outcome, follow-up, and perioperative anticoagulant treatment.
enoxaparin
equine cardiology
iatrogenic atrial septal defect
left heart catheterization
ultrasound
Journal
Journal of veterinary internal medicine
ISSN: 1939-1676
Titre abrégé: J Vet Intern Med
Pays: United States
ID NLM: 8708660
Informations de publication
Date de publication:
31 Jul 2024
31 Jul 2024
Historique:
received:
03
05
2024
accepted:
18
07
2024
medline:
1
8
2024
pubmed:
1
8
2024
entrez:
1
8
2024
Statut:
aheadofprint
Résumé
Cardiac catheterizations in horses are mainly performed in the right heart, as access to the left heart traditionally requires an arterial approach. Transseptal puncture (TSP) has been adapted for horses but data on follow-up and closure of the iatrogenic atrial septal defect (iASD) are lacking. To perform TSP and assess postoperative complications and iASD closure over a minimum of 4 weeks. Eleven healthy adult horses. Transseptal puncture was performed under general anesthesia. Serum cardiac troponin I concentrations were measured before and after puncture. Weekly, iASD closure was monitored using transthoracic and intracardiac echocardiography. Relationship between activated clotting time and anti-factor Xa activity during postoperative enoxaparin treatment was assessed in vitro and in vivo. Transseptal puncture was successfully achieved in all horses within a median duration of 22 (range, 10-104) minutes. Balloon dilatation of the puncture site for sheath advancement was needed in 4 horses. Atrial arrhythmias occurred in 9/11 horses, including atrial premature depolarizations (N = 1), atrial tachycardia (N = 5), and fibrillation (N = 3). Serum cardiac troponin I concentrations increased after TSP, but remained under the reference value in 10/11 horses. Median time to iASD closure was 14 (1-35) days. Activated clotting time correlated with anti-factor Xa activity in vitro but not in vivo. Transseptal puncture was successfully performed in all horses. The technique was safe and spontaneous iASD closure occurred in all horses. Clinical application of TSP will allow characterization and treatment of left-sided arrhythmias in horses.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiac catheterizations in horses are mainly performed in the right heart, as access to the left heart traditionally requires an arterial approach. Transseptal puncture (TSP) has been adapted for horses but data on follow-up and closure of the iatrogenic atrial septal defect (iASD) are lacking.
HYPOTHESIS/OBJECTIVES
OBJECTIVE
To perform TSP and assess postoperative complications and iASD closure over a minimum of 4 weeks.
ANIMALS
METHODS
Eleven healthy adult horses.
METHODS
METHODS
Transseptal puncture was performed under general anesthesia. Serum cardiac troponin I concentrations were measured before and after puncture. Weekly, iASD closure was monitored using transthoracic and intracardiac echocardiography. Relationship between activated clotting time and anti-factor Xa activity during postoperative enoxaparin treatment was assessed in vitro and in vivo.
RESULTS
RESULTS
Transseptal puncture was successfully achieved in all horses within a median duration of 22 (range, 10-104) minutes. Balloon dilatation of the puncture site for sheath advancement was needed in 4 horses. Atrial arrhythmias occurred in 9/11 horses, including atrial premature depolarizations (N = 1), atrial tachycardia (N = 5), and fibrillation (N = 3). Serum cardiac troponin I concentrations increased after TSP, but remained under the reference value in 10/11 horses. Median time to iASD closure was 14 (1-35) days. Activated clotting time correlated with anti-factor Xa activity in vitro but not in vivo.
CONCLUSIONS AND CLINICAL IMPORTANCE
CONCLUSIONS
Transseptal puncture was successfully performed in all horses. The technique was safe and spontaneous iASD closure occurred in all horses. Clinical application of TSP will allow characterization and treatment of left-sided arrhythmias in horses.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Fonds Wetenschappelijk Onderzoek
ID : 1S71521N
Organisme : Fonds Wetenschappelijk Onderzoek
ID : 1SA2223N
Organisme : Fonds Wetenschappelijk Onderzoek
ID : 1SE9122N
Organisme : Bijzonder Onderzoeksfonds UGent
ID : 01B05818
Informations de copyright
© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Références
Van Steenkiste G, Boussy T, Duytschaever M, et al. Detection of the origin of atrial tachycardia by 3D electro‐anatomical mapping and treatment by radiofrequency catheter ablation in horses. J Vet Intern Med. 2022;36:1481‐1490.
Buschmann E, Van Steenkiste G, Boussy T, et al. Three‐dimensional electro‐anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: a case report. J Vet Intern Med. 2023;37:728‐734.
Schwarzwald CC, Hamlin RL, Bonagura JD, Nishijima Y, Meadows C, Carnes CA. Atrial, SA nodal and AV nodal electrophysiology in standing horses: normal findings and electrophysiologic effects of quinidine and diltiazem. J Vet Intern Med. 2007;21:166‐175.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373‐498.
Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659‐666.
Vandecasteele T, Van Den Broeck W, Tay H, et al. 3D reconstruction of the porcine and equine pulmonary veins, supplemented with the identification of telocytes in the horse. Anat Histol Embryol. 2018;47:145‐152.
Linz D, Hesselkilde E, Kutieleh R, Jespersen T, Buhl R, Sanders P. Pulmonary vein firing initiating atrial fibrillation in the horse: oversized dimensions but similar mechanisms. J Cardiovasc Electrophysiol. 2020;31:1211‐1212.
Kjeldsen ST, Nissen SD, Saljic A, et al. Structural and electro‐anatomical characterization of the equine pulmonary veins: implications for atrial fibrillation. J Vet Cardiol. 2024;52:1‐13.
Vernemmen I, Van Steenkiste G, Buschmann E, et al. Development of an atrial transseptal puncture procedure in horses to access the left heart: an ultrasound‐guided jugular vein and transhepatic approach. Equine Vet J. 2024. doi:10.1111/evj.14084
Kavinsky CJ, Szerlip M, Goldsweig AM, et al. SCAI guidelines for the management of patent foramen ovale. J Soc Cardiovasc Angiogr Interv. 2022;1:100039.
Schwarzwald CC, Feige K, Wunderli‐Allenspach H, Braun U. Comparison of pharmacokinetic variables for two low‐molecular weight heparins after subcutaneous administration of a single dose to horses. Am J Vet Res. 2002;63:868‐873.
Tennent‐Brown BS, Epstein KL, Whelchel DD, Giguère S. Use of viscoelastic coagulation testing to monitor low molecular weight heparin administration to healthy horses. J Vet Emerg Crit Care (San Antonio). 2013;23:291‐299.
Vernemmen I, Paulussen E, Dauvillier J, Decloedt A, van Loon G. Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale. J Vet Intern Med. 2022;36:1535‐1542.
Alkhouli M, Rihal CS, Holmes DR Jr. Transseptal techniques for emerging structural heart interventions. JACC Cardiovasc Interv. 2016;9:2465‐2480.
Zadeh AA, Cannom DS, Macrum BL, et al. The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2011;22:822‐824.
Almendarez M, Alvarez‐Velasco R, Pascual I, Alperi A, Moris C, Avanzas P. Transseptal puncture: review of anatomy, techniques, complications and challenges, a critical view. Int J Cardiol. 2022;351:32‐38.
Pedra CAC, Neves JR, Pedra SRF, et al. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv. 2007;70:731‐739.
Marcus GM, Ren XS, Tseng ZH, et al. Repeat transseptal catheterization after ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:55‐59.
Yoshida K, Yoshikawa J, Akasaka T, et al. Assessment of left‐to‐right atrial shunting after percutaneous mitral valvuloplasty by transesophageal color Doppler flow‐mapping. Circulation. 1989;80:1521‐1526.
Alkhouli M, Sarraf M, Zack CJ, Holmes DR, Rihal CS. Iatrogenic atrial septal defect following transseptal cardiac interventions. Int J Cardiol. 2016;209:142‐148.
Nagy Z, Kis Z, Geczy T, et al. Prospective evaluation of iatrogenic atrial septal defect after cryoballoon or radiofrequency catheter ablation of atrial fibrillation‐"EVITA" study. J Interv Card Electrophysiol. 2019;56:19‐27.
Mugnai G, Sieira J, Ciconte G, et al. One year incidence of atrial septal defect after PV isolation: a comparison between conventional radiofrequency and Cryoballoon ablation. Pacing Clin Electrophysiol. 2015;38:1049‐1057.
Rillig A, Meyerfeldt U, Birkemeyer R, Treusch F, Kunze M, Jung W. Persistent iatrogenic atrial septal defect after pulmonary vein isolation: incidence and clinical implications. J Interv Card Electrophysiol. 2008;22:177‐181.
Singh SM, Douglas PS, Reddy VY. The incidence and long‐term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ Arrhythm Electrophysiol. 2011;4:166‐171.
Chan NY, Choy CC, Yuen HC, Chow HF, Fong HF. A very long‐term longitudinal study on the evolution and clinical outcomes of persistent iatrogenic atrial septal defect after Cryoballoon ablation. Can J Cardiol. 2019;35:396‐404.
Davies A, Gunaruwan P, Collins N, Barlow M, Jackson N, Leitch J. Persistent iatrogenic atrial septal defects after pulmonary vein isolation: long‐term follow‐up with contrast transesophageal echocardiography. J Interv Card Electrophysiol. 2017;48:99‐103.
Linhart M, Werner JT, Stockigt F, et al. High rate of persistent iatrogenic atrial septal defect after single transseptal puncture for cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol. 2018;52:141‐148.
Sieira J, Chierchia GB, Di Giovanni G, et al. One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25:11‐15.
Schueler R, Ozturk C, Wedekind JA, et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv. 2015;8:450‐459.
Ishikura F, Nagata S, Yasuda S, Yamashita N, Miyatake K. Residual atrial septal perforation after percutaneous transvenous mitral commissurotomy with Inoue balloon catheter. Am Heart J. 1990;120:873‐878.
Nelles D, Vij V, Al‐Kassou B, et al. Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion. Echocardiography. 2022;39:65‐73.
Toyama K, Rader F, Kar S, et al. Iatrogenic atrial septal defect after percutaneous mitral valve repair with the MitraClip system. Am J Cardiol. 2018;121:475‐479.
Rillig A, Meyerfeldt U, Kunze M, et al. Persistent iatrogenic atrial septal defect after a single‐puncture, double‐transseptal approach for pulmonary vein isolation using a remote robotic navigation system: results from a prospective study. Europace. 2010;12:331‐336.
Blanc JJ, Almendral J, Brignole M, et al. Consensus document on antithrombotic therapy in the setting of electrophysiological procedures. Europace. 2008;10:513‐527.
Bates SM, Weitz JI. Coagulation assays. Circulation. 2005;112:e53‐e60.
Hellemans A, Devriendt N, De Somer F, et al. Reference interval, longitudinal variability and reliability of activated clotting time in healthy dogs using a point‐of‐care analyser. Vet Med Sci. 2023;9:1534‐1540.
Navas de Solis C, Reef VB, Slack J, et al. Evaluation of coagulation and fibrinolysis in horses with atrial fibrillation. J Am Vet Med Assoc. 2016;248:201‐206.
Hammerstingl C, Lickfett L, Jeong KM, et al. Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—an underestimated risk? Am Heart J. 2006;152:362.
Meschia JF, Bushnell C, Boden‐Albala B, et al. Guidelines for the primary prevention of stroke a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:3754‐3832.
Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm. 2020;17:E2‐E154.
Buschmann E, Van Steenkiste G, Duytschaever M, et al. Successful caudal vena cava and pulmonary vein isolation in healthy horses using 3D electro‐anatomical mapping and a contact force‐guided ablation system. Equine Vet J. 2023. doi:10.1111/evj.14037
Fareed J, Hoppensteadt D, Walenga J, et al. Pharmacodynamic and pharmacokinetic properties of enoxaparin. Clin Pharmacokinet. 2003;42:1043‐1057.
Hirsh J, Anand SS, Halperin JL, Fuster V. A guide to anticoagulant therapy: Heparine. Circulation. 2001;103:2994‐3018.
Frum J, Havill K, Andrews C, et al. Anticoagulant profile of subcutaneous enoxaparin in healthy dogs. J Vet Pharmacol Ther. 2022;45:34‐45.
Henry TD, Satran D, Knox LL, Iacarella CL, Laxson DD, Antman EM. Are activated clotting times helpful in the management of anticoagulation with subcutaneous low‐molecular‐weight heparin? Am Heart J. 2001;142:590‐593.
Lawrence M, Mixon TA, Cross D, Gantt DS, Dehmer GJ. Assessment of anticoagulation using activated clotting times in patients receiving intravenous enoxaparin during percutaneous coronary intervention. Catheter Cardiovasc Interv. 2004;61:52‐55.
Veldtman GR, Hartley A, Visram N, Benson LN. Radiofrequency applications in congenital heart disease. Expert Rev Cardiovasc Ther. 2004;2:117‐126.
Jesty SA, Kraus M, Gelzer AR, Rishniw M, Moïse NS. Effect of transvenous electrical cardioversion on plasma cardiac troponin I concentrations in horses with atrial fibrillation. J Vet Intern Med. 2009;23:1103‐1107.
Tisotti T, Sanchez A, Nickell J, Smith CK, Hofmeister E. Retrospective evaluation of acute hyperkalemia of unknown origin during general anesthesia in dogs. Vet Anaesth Analg. 2023;50:129‐135.
Moore BR, Hinchcliff KW. Heparin: a review of its pharmacology and therapeutic use in horses. J Vet Intern Med. 1994;8:26‐35.
Sticherling C, Marin F, Birnie D, et al. Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace. 2015;17:1197‐1214.
Meyers KM, Lindner C, Katz J, Grant B. Phenylbutazone inhibition of equine platelet‐function. Am J Vet Res. 1979;40:265‐270.
Semrad SD, Hardee GE, Hardee MM, Moore JN. Flunixin meglumine given in small doses—pharmacokinetics and prostaglandin inhibition in healthy horses. Am J Vet Res. 1985;46:2474‐2479.
Burkett BN, Thomason JM, Hurdle HM, Wills RW, Fontenot RL. Effects of firocoxib, flunixin meglumine, and phenylbutazone on platelet function and thromboxane synthesis in healthy horses. Vet Surg. 2016;45:1087‐1094.
Jamieson CA, Hanzlicek AS, Payton ME, Holbrook TC. Normal reference intervals and the effects of sample handling on dynamic viscoelastic coagulometry (Sonoclot) in healthy adult horses. J Vet Emerg Crit Care (San Antonio). 2018;28:39‐44.