Kjeldsen Sofie Troest, Nissen Sarah D, Christensen Nina C, Haugaard Simon L, Schneider Mélodie J, Vinther Zenta, Sattler Stefan M, Carstensen Helena, Jøns Christian, Hopster-Iversen Charlotte, Buhl Rikke
Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte, Denmark.
Equine Vet J. 2025 Mar;57(2):449-458. doi: 10.1111/evj.14112. Epub 2024 Jun 21.
Paroxysmal atrial fibrillation (pAF) occurs sporadically and can impair athletic performance. Gold standard for diagnosis is surface electrocardiography (ECG), however, this requires AF to be sustained. Implantable loop recorders (ILRs) are routinely used for AF detection in human medicine. While ILR placement has been studied in horses, its AF detection performance is unknown.
(I) Validation of ILRs for AF detection in horses. (II) Determining pAF incidence using ILRs and estimate the positive predictive value (PPV).
(I) Experimental study; (II) Longitudinal observational study.
(I) Implantation of ILRs in 15 horses with AF and 13 horses in sinus rhythm. Holter ECGs were recorded at: 1, 4, 8, 12 and 16 weeks of AF. The ILR ECGs were compared with surface ECGs to assess diagnostic sensitivity and specificity. (II) Eighty horses (43 Warmbloods, 37 Standardbreds) with ILRs were monitored for 367 days [IQR 208-621].
(I) ILRs detected AF on all recording days, in horses with AF, with a sensitivity of 66.1% (95% CI: 65.8-66.5) and a specificity of 99.99% (95% CI: 99.97-99.99). The sensitivity remained consistent across all time points. (II) The incidence of pAF was 6.3% (5/80). In horses with pAF, the PPV ranged from 8% to 87%. Increased body condition score (BCS > 6/9) was associated with an increased number of false positive episodes (p = 0.005).
(I) Horses were stabled during the ECG recordings, and AF was induced, rather than naturally occurring pAF. (II) Integrated algorithm in this ILR is optimised for AF detection in humans using remote monitors. Additionally, sensing is affected by motion artefacts.
The ILR reliably detected AF in resting horses, particularly in horses with normal BCS (6/9). The ILR proved useful to detect pAF and is recommended alongside Holter monitoring for diagnostic workup of horses with suspected pAF.
阵发性心房颤动（pAF）偶发，会影响运动表现。诊断的金标准是体表心电图（ECG），然而这需要房颤持续存在。植入式循环记录仪（ILR）在人类医学中常用于房颤检测。虽然已经对马的ILR植入进行了研究，但其房颤检测性能尚不清楚。
（I）验证ILR在马房颤检测中的应用。（II）使用ILR确定pAF发病率并估计阳性预测值（PPV）。
（I）实验研究；（II）纵向观察研究。
（I）对15匹患有房颤的马和13匹窦性心律的马植入ILR。在房颤的第1、4、8、12和16周记录动态心电图。将ILR心电图与体表心电图进行比较，以评估诊断敏感性和特异性。（II）对80匹植入ILR的马（43匹温血马，37匹标准赛马）进行了367天的监测[四分位距208 - 621]。
（I）ILR在所有记录日都能检测到患有房颤的马的房颤，敏感性为66.1%（95%可信区间：65.8 - 66.5），特异性为99.99%（95%可信区间：99.97 - 99.99）。所有时间点的敏感性保持一致。（II）pAF发病率为6.3%（5/80）。在患有pAF的马中，PPV范围为8%至87%。体况评分增加（BCS＞6/9）与假阳性发作次数增加相关（p = 0.005）。
（I）心电图记录期间马被圈养，且房颤是诱发的，而非自然发生的pAF。（II）此ILR中的集成算法是针对使用远程监测器的人类房颤检测进行优化的。此外，传感受运动伪影影响。
ILR能可靠地检测静息马的房颤，尤其是体况评分正常（6/9）的马。ILR被证明对检测pAF有用，建议与动态心电图监测一起用于疑似pAF马的诊断检查。
