Successful application of closed loop stimulation pacemakers with remote monitoring in 3 miniature donkeys with syncope.
Authors: De Lange Lisa, Van Steenkiste Glenn, Vernemmen Ingrid, Vera Lisse, Cromheeke Kristel M C, Walser Ulla, Meert Hans, Decloedt Annelies, van Loon Gunther
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Third-degree atrioventricular (AV) block causes recurrent syncope in equines and can be fatal; whilst pacemaker implantation is the definitive treatment, achieving physiologically appropriate rate response during variable activity levels remains challenging in veterinary patients. De Lange and colleagues implanted rate-adaptive single-chamber pacemakers equipped with closed-loop stimulation (CLS) technology and remote monitoring capability into three miniature donkeys presenting with complete AV block and syncope, subsequently evaluating pacing performance during rest, stress, and exercise. The CLS algorithm demonstrated superior rate adaptation by matching pacing output to actual atrial rates across all activity states, eliminating the fixed-rate limitations of conventional pacemakers and reducing the risk of rate-related complications. Remote monitoring functionality enabled daily automated data transmission via a stable-installed transmitter, allowing clinicians to diagnose arrhythmias and device malfunction remotely without requiring in-hand evaluation. For practitioners managing equine cardiac cases, this work suggests that modern closed-loop technology can deliver near-physiological heart rate modulation whilst remote monitoring substantially reduces owner burden and facilitates early detection of complications, though broader clinical adoption will depend on cost considerations and availability of compatible devices in equine settings.
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Practical Takeaways
- •Advanced pacemaker technology with remote monitoring can successfully treat syncope from complete heart block in equids, allowing off-site patient monitoring without frequent clinic visits
- •Closed loop stimulation provides more physiological rate responses than fixed-rate pacing, potentially improving exercise tolerance and quality of life in affected animals
- •While applicable to miniature donkeys in this case, similar technology may have potential for larger equines with conduction disorders, though cost and implantation expertise currently limit clinical adoption
Key Findings
- •Closed loop stimulation pacemakers achieved physiological heart rate adaptation in 3 miniature donkeys with third-degree AV block
- •Remote monitoring via wireless home monitoring system enabled daily transmission of pacemaker functional data and detection of arrhythmias from distance
- •Pacing rates correlated with actual atrial rates during rest, stress, and physical exercise, demonstrating rate-adaptive functionality