Effects of acute atrial fibrillation and cardioversion on left and right atrial pressures in a dog

The occurrence of right-sided congestive heart failure (CHF) in dogs with left-sided heart disease is well-recognized, but its mechanisms are incompletely understood. A 12-year-old Maltese dog was admitted to the clinic for left atrial decompression to treat recurrent CHF due to severe myxomatous mitral valve disease (MMVD). Left atrial decompression was successful but atrial fibrillation (AF) occurred during the procedure. Electric cardioversion restored normal sinus rhythm (NSR) and the dog's recovery was uneventful. This sequence of events made it possible to study intracameral pressures individually in each atrium in a dog with naturally occurring MMVD during AF and again during NSR. Although pressures in both atria declined following cardioversion, the right atrial pressure declined to a greater degree. These findings indicated a disproportionate effect of AF on right atrial pressure. This difference was noteworthy given the long-standing clinical observation that dogs with MMVD have a higher prevalence of right-sided CHF when AF is present. Key clinical message: A dog with MMVD had a greater reduction in right atrial pressure than in left atrial pressure when its AF was cardioverted as part of a cardiac catheterization procedure. This observation proposed a mechanism for the well-known but unexplained observation that dogs with MMVD manifest right-sided CHF disproportionately more often when they have AF.