Early recognition with capnography, and successful resuscitation, of severe cardiac dysfunction in a horse receiving amiodarone during transvenous electric cardioversion (TVEC)

Abstract

SummaryA 19‐year‐old Cob mare with atrial fibrillation (AF) presented for transvenous electric cardioversion (TVEC). Under general anaesthesia, three successive incremental electric shocks were given (total 750 J) and sinus rhythm was temporarily restored. After 13 s, AF recurred so a fourth shock (300 J) was given and intravenous (IV) amiodarone started. Shortly after, capnography revealed an acute drop in the end‐tidal carbon dioxide, which was followed by agonal gasping. Echocardiography showed severe cardiac dysfunction. Successful cardiac resuscitation consisted, among others, of cessation of amiodarone and administration of dobutamine and adrenaline. This case report highlights the importance of capnography as a non‐invasive means of cardiac output monitoring in equine anaesthesia which definitely contributed to a positive outcome in this case. It also emphasises the critical importance of early recognition and communication of complications within anaesthetic and cardiology teams.

Anti‐arrhythmic drugs before, during and after transvenous electrical cardioversion of atrial fibrillation in horses: Weighing the benefits and risks

“…Over the past years, this has led to increased use of anti-arrhythmic drugs before, during and after TVEC in order to facilitate cardioversion and prevent recurrence. As described in the case report by Pye et al (2024), using anti-arrhythmic drugs during TVEC is not without risk. Pye et al describe severe cardiac dysfunction after administration of amiodarone during TVEC to prevent IRAF.…”

“…Similarly, the case of Pye et al (2024) demonstrates the potential dangers of amiodarone administration. Severe cardiac dysfunction occurred shortly after the onset of a 2.5 mg/kg bwt amiodarone infusion.…”