Evaluation of the diagnostic value of an implantable loop recorder in dogs with unexplained syncope

Roberto A. Santilli Clinica Veterinaria Malpensa, Via Marconi, 27, 21017 Samarate, Varese, Italy.

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Luca Ferasin Anderson Sturgess Veterinary Specialists, Bunstead Barns, Poles Lane, Hursely, Winchester, Hampshire, SO21 2LL, England.

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Simona G. Voghera Clinica Veterinaria Malpensa, Via Marconi, 27, 21017 Samarate, Varese, Italy.

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Manuela Perego Clinica Veterinaria Malpensa, Via Marconi, 27, 21017 Samarate, Varese, Italy.

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Abstract

Objective—To evaluate the diagnostic value of an implantable loop recorder (ILR) in dogs with unexplained syncope.

Design—Prospective case series.

Animals—12 dogs with recurrent unexplained syncope.

Procedures—An ILR was surgically inserted in a pocket created in the subcutaneous tissues of the left hemithorax of each dog. The ILRs were programmed for manual and automatic activation, and event analysis and programming were performed at 3-month intervals and after each syncopal episode.

Results—The ILR was manually activated in 7 of 12 dogs at least once within 45 to 218 days (median, 120 days) after implantation. Four dogs had syncopal episodes associated with sinus tachycardia followed by sinus bradycardia and asystolic pauses. Two dogs had ventricular tachycardia, and 1 dog had sinus node dysfunction with prolonged sinus arrest that coincided with loss of consciousness and falling. Four dogs had no additional syncopal episodes after implantation of the ILR. In the remaining dog, the owner was unable to activate the ILR during the only syncopal episode observed for that dog after ILR implantation. In all 12 dogs, analysis of ECG traces after automatic activation of recording revealed normal cardiac rhythms.

Conclusions and Clinical Relevance—Data gained after manual activation of an ILR provided valuable diagnostic and prognostic information in almost all dogs with unexplained syncopal episodes by confirming or disproving an association between syncope and arrhythmias. However, detection of disturbances in cardiac rhythm after automatic activation did not appear to improve the diagnostic value for an ILR implanted in dogs.

Abstract

Objective—To evaluate the diagnostic value of an implantable loop recorder (ILR) in dogs with unexplained syncope.

Design—Prospective case series.

Animals—12 dogs with recurrent unexplained syncope.

Procedures—An ILR was surgically inserted in a pocket created in the subcutaneous tissues of the left hemithorax of each dog. The ILRs were programmed for manual and automatic activation, and event analysis and programming were performed at 3-month intervals and after each syncopal episode.

Results—The ILR was manually activated in 7 of 12 dogs at least once within 45 to 218 days (median, 120 days) after implantation. Four dogs had syncopal episodes associated with sinus tachycardia followed by sinus bradycardia and asystolic pauses. Two dogs had ventricular tachycardia, and 1 dog had sinus node dysfunction with prolonged sinus arrest that coincided with loss of consciousness and falling. Four dogs had no additional syncopal episodes after implantation of the ILR. In the remaining dog, the owner was unable to activate the ILR during the only syncopal episode observed for that dog after ILR implantation. In all 12 dogs, analysis of ECG traces after automatic activation of recording revealed normal cardiac rhythms.

Conclusions and Clinical Relevance—Data gained after manual activation of an ILR provided valuable diagnostic and prognostic information in almost all dogs with unexplained syncopal episodes by confirming or disproving an association between syncope and arrhythmias. However, detection of disturbances in cardiac rhythm after automatic activation did not appear to improve the diagnostic value for an ILR implanted in dogs.

Contributor Notes

Dr. Ferasin's present address is Specialist Veterinary Cardiology Consultancy, 20 Old Bath Rd, Newbury, Berkshire, RG14 1QL, England.

Presented in abstract form at the 17th Annual Congress of the European College of Veterinary Internal Medicine-Companion Animals, Budapest, September 2007.

The authors thank Dr. Kit Sturgess for clinical assistance with 1 of the dogs.

Address correspondence to Dr. Santilli (rasantil@tin.it).
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