Three-dimensional electro-anatomical mapping and radiofrequency ablation as a novel treatment for atrioventricular accessory pathway in a horse: A case report.
Authors: Buschmann Eva, Van Steenkiste Glenn, Boussy Tim, Vernemmen Ingrid, Schauvliege Stijn, Decloedt Annelies, van Loon Gunther
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary Atrioventricular accessory pathways represent an uncommon but potentially serious conduction abnormality in horses, manifesting as pre-excitation on ECG and potentially predisposing to arrhythmias; this case report documents the successful application of three-dimensional electro-anatomical mapping (3D EAM) and radiofrequency catheter ablation (RFCA)—technologies previously confined to human cardiology—in a single equine patient presenting with intermittent ventricular pre-excitation characterised by shortened PQ intervals and abnormal QRS morphology. The diagnostic workup combined conventional 12-lead ECG and vectorcardiography to localise the accessory pathway to the right cranial region, before 3D EAM provided precise anatomical targeting for ablation therapy under general anaesthesia. Although occasional pre-excited complexes persisted immediately post-recovery, 24-hour ambulatory monitoring and ridden exercise ECGs at one and six weeks confirmed complete elimination of pre-excitation, demonstrating sustained efficacy beyond the acute perioperative period. Whilst this remains a single case and the long-term prognosis for accessory pathway-related arrhythmias in horses remains incompletely understood, this report establishes the technical feasibility of catheter-based ablation in equine patients and may represent a treatment avenue for horses with symptomatic or exercise-limiting pre-excitation where conventional antiarrhythmic approaches have proven inadequate. Practitioners should consider referral for specialist cardiology evaluation and potential ablation therapy in cases of documented pre-excitation, particularly where clinical signs suggest haemodynamic compromise or performance limitation.
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Practical Takeaways
- •Horses presenting with intermittent pre-excitation on ECG (short PQ interval with abnormal QRS morphology) may be candidates for 3D electro-anatomical mapping and radiofrequency ablation rather than medical management alone
- •Advanced catheter ablation techniques previously used in human and small animal cardiology can be successfully adapted for equine cardiac arrhythmia treatment
- •Post-procedure monitoring should include 24-hour Holter ECG and exercise ECG testing to confirm complete elimination of pre-excitation
Key Findings
- •3D electro-anatomical mapping successfully localized an atrioventricular accessory pathway in the right cranial location of the heart in a horse
- •Radiofrequency catheter ablation eliminated accessory pathway conduction with complete disappearance of pre-excitation on 24-hour ECG and exercise ECG at 1 and 6 weeks post-procedure
- •3D EAM and RFCA are feasible techniques for diagnosis and treatment of accessory pathways in equine patients