Fibrilhação atrial no cão: estudo de casos clínicos e de diferentes abordagens terapêuticas
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2019-10-18
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A fibrilhação atrial é a arritmia cardíaca supraventricular mais frequente em cães. O tratamento desta arritmia pode ser realizado por cardioversão ou por ablação por cateter. A cardioversão, para restabelecer o ritmo cardíaco sinusal, pode ser farmacológica (antiarrítmicos) ou elétrica (choque elétrico transtorácico). Deste modo, os objetivos deste trabalho foram determinar o sucesso da cardioversão elétrica transtorácica no tratamento de fibrilhação atrial em cães, e avaliar se é um método de tratamento viável para ser realizado com sucesso na prática clínica diária. Os casos clínicos incluídos neste trabalho foram observados no Hospital Veterinari Molins em Barcelona, entre o dia 23 de Setembro e o dia 23 de Dezembro de 2018. Foram analisados quatro casos clínicos de cães com fibrilhação atrial, sendo que em dois destes casos, os animais tinham uma doença cardíaca associada à arritmia. O tratamento inicial da fibrilhação atrial foi realizado com antiarrítmicos (amiodarona, digoxina, diltiazem, esmolol, lidocaína) de acordo com cada caso clínico. Os quatro animais foram refratários ao tratamento farmacológico e procedeu-se à cardioversão elétrica transtorácica. Em dois dos casos clínicos foi necessário mais do que um processo de cardioversão elétrica transtorácica para recuperar o ritmo sinusal. A cardioversão elétrica transtorácica revelou-se eficaz no tratamento dos três cães com fibrilhação atrial aguda, quando associado a um tratamento farmacológico após a cardioversão. No animal que tinha uma fibrilhação atrial crónica, associada a cardiomiopatia dilatada, verificou-se que este método não foi eficaz; ocorreu uma diminuição da frequência ventricular, mas não uma conversão para um ritmo sinusal, pelo que se realizou o controlo da arritmia através do tratamento da doença cardíaca subjacente. Um dos animais do estudo morreu após o procedimento devido a complicações associadas ao desenvolvimento de edema pulmonar. Com a realização deste trabalho pode concluir-se que a cardioversão elétrica transtorácica é eficaz para o tratamento da fibrilhação atrial, sendo que, quando associada a um tratamento farmacológico após a cardioversão, permite que o animal mantenha um ritmo sinusal normal a longo prazo. É um tratamento que pode ser realizado de forma segura na prática clínica, desde que o Médico Veterinário tenha os conhecimentos e a experiência necessários para a realização deste procedimento. No entanto, o número de casos clínicos analisado foi pequeno, pelo que devem ser realizados estudos com um número maior de animais.
Atrial fibrillation is the most frequent supraventricular arrythmia in dogs. The treatment of this arrythmia can be performed by cardioversion or catheter ablation. Cardioversion, to restore sinus cardiac rhythm, may be pharmacological (with antiarrhythmics) or electrical (thransthoracic electric shock). The objectives of this study were to determine the success of thransthoracic electrical cardioversion in the treatment of atrial fibrillation in dogs and to evaluate whether it is a viable treatment method to be applied successfully in daily clinical practice. The data analyzed in this paper were collected during the externship at the Hospital Veterinari Molins in Barcelona, between the 23rd September and 23rd December of 2018. Four clinical cases of dogs with atrial fibrillation were analyzed, and in two of these cases the animals had heart disease associated with the arrhythmia. The initial treatment of atrial fibrillation was performed with antiarrhythmics (amiodarone, digoxin, diltiazem, esmolol and lidocaine) according to each clinical case. All four animal were refractory to pharmacological treatment and transthoracic electrical cardioversion was performed. In two of the animals, more than one transthoracic electrical cardioversion was necessary to recover to a sinus rhythm. Transthoracic electrical cardioversion proved to be effective in the treatment of three dogs with acute atrial fibrillation, when the pharmacological treatment was associated after the procedure. In animal that had chronic atrial fibrillation associated with dilated cardiomyopathy, this method was found to be ineffective although there was a decrease in ventricular rate but not a cardioversion to sinus rhythm. In this case, the control of the arrythmia was achieved by treatment of the underlying heart disease. One of the animals from the study died after the procedure due to complications associated with the development of pulmonary edema. In conclusion, the process of transthoracic electrical cardioversion is an effective method for the treatment of atrial fibrillation which, when associated with a pharmacological treatment, allows the cardioversion to a sinus rhythm long term. This is a treatment that can be safely performed in clinical practice as long as the veterinarian has the necessary knowledge and experience to carry out the procedure. However, the number of clinical cases analyzed was to small, therefore, more extensive studies should be carried out in order to verify the effectiveness of this procedure.
Atrial fibrillation is the most frequent supraventricular arrythmia in dogs. The treatment of this arrythmia can be performed by cardioversion or catheter ablation. Cardioversion, to restore sinus cardiac rhythm, may be pharmacological (with antiarrhythmics) or electrical (thransthoracic electric shock). The objectives of this study were to determine the success of thransthoracic electrical cardioversion in the treatment of atrial fibrillation in dogs and to evaluate whether it is a viable treatment method to be applied successfully in daily clinical practice. The data analyzed in this paper were collected during the externship at the Hospital Veterinari Molins in Barcelona, between the 23rd September and 23rd December of 2018. Four clinical cases of dogs with atrial fibrillation were analyzed, and in two of these cases the animals had heart disease associated with the arrhythmia. The initial treatment of atrial fibrillation was performed with antiarrhythmics (amiodarone, digoxin, diltiazem, esmolol and lidocaine) according to each clinical case. All four animal were refractory to pharmacological treatment and transthoracic electrical cardioversion was performed. In two of the animals, more than one transthoracic electrical cardioversion was necessary to recover to a sinus rhythm. Transthoracic electrical cardioversion proved to be effective in the treatment of three dogs with acute atrial fibrillation, when the pharmacological treatment was associated after the procedure. In animal that had chronic atrial fibrillation associated with dilated cardiomyopathy, this method was found to be ineffective although there was a decrease in ventricular rate but not a cardioversion to sinus rhythm. In this case, the control of the arrythmia was achieved by treatment of the underlying heart disease. One of the animals from the study died after the procedure due to complications associated with the development of pulmonary edema. In conclusion, the process of transthoracic electrical cardioversion is an effective method for the treatment of atrial fibrillation which, when associated with a pharmacological treatment, allows the cardioversion to a sinus rhythm long term. This is a treatment that can be safely performed in clinical practice as long as the veterinarian has the necessary knowledge and experience to carry out the procedure. However, the number of clinical cases analyzed was to small, therefore, more extensive studies should be carried out in order to verify the effectiveness of this procedure.
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Dissertação de Mestrado Integrado em Medicina Veterinária
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Cães , Cardiologia