Implantable loop recorders can detect paroxysmal atrial fibrillation in Standardbred racehorses with intermittent poor performance

• Published in: Equine veterinary journal Vol. 53; no. 5; pp. 955 - 963
• Main Authors: Buhl, Rikke, Nissen, Sarah D., Winther, Marie L. K., Poulsen, Sofie K., Hopster‐Iversen, Charlotte, Jespersen, Thomas, Sanders, Prashanthan, Carstensen, Helena, Hesselkilde, Eva M.
• Format: Journal Article
• Language: English
• Published: Fordham Wiley Subscription Services, Inc 01-09-2021; John Wiley and Sons Inc
• Subjects: Cardiac arrhythmia; cardiology; Descriptive Clinical Reports; horse; Horses; implantable loop recorder; paroxysmal atrial fibrillation
• ISSN: 0425-1644; 2042-3306
• DOI: 10.1111/evj.13372

Background
Limited information is available on paroxysmal atrial fibrillation (PAF) in the horse. Indeed, undiagnosed PAF could result in poor performance. Due to the intermittent occurrence, PAF is difficult to diagnose. However, implanting a small ECG device (implantable loop recorder, ILR) subcutaneously, allows the continuous and automatic detection of PAF.
Objectives
The aim was to investigate the potential of ILRs as a tool for diagnosing PAF in horses with poor performance.
Study design
Prospective field study.
Methods
Twelve racing Standardbred trotters with intermittent reduced performance (mean age: six years) were enrolled prospectively. The ILR was implanted subcutaneously at the fifth or sixth left intercostal space and data from the ILR was collected during the study period in which the horses were followed for a median duration of 7.5 month (range 6‐28).
Results
The ILR was able to detect PAF in four out of twelve racehorses. The ILR also detected sustained atrial fibrillation (AF) in one horse during the study. The ILRs rely on RR detection and R waves were correctly identified in 96%. One hundred episodes were categorised as AF by the ILRs and subsequently visual ECG inspection categorised 12 as sinus rhythm (SR), 28 as sinus arrhythmia (SA), 14 as other arrhythmias and 46 as AF episodes. The Root Mean Square of the Successive Differences (RMSSD) values were significantly increased for AF compared to SR and SA.
Main limitations
Few horses included and duration of study period varied among the horses. Further it was not possible to assess the sensitivity of the device in the current study and the ILRs proved to have a high rate of false positive misclassifications.
Conclusions
This study indicates that ILRs can be used for detection of PAF episodes and could be a useful ECG tool for horses presenting with poor performance. This methodology provides a platform to facilitate the long‐term assessment of AF development and quantification of AF burden in horses. Further studies including both healthy and poor performing horses are needed in order to learn more about PAF prevalence in racehorses.