Transcutaneous electrocardioversion for treatment of atrial fibrillation and congestive heart failure in a Nubian...

We describe the novel treatment of idiopathic atrial fibrillation (AF) and congestive heart failure (CHF) in a 10-year-old Nubian wether presented because of suspected hepatopathy. Physical examination findings, including irregularly irregular rhythm, tachycardia, bilateral jugular venous distention and pulsation, and ventral edema, raised concerns for primary cardiac disease. Findings of the echocardiogram, electrocardiogram, and ultrasound examinations supported the diagnosis of AF and CHF. Treatment was initially directed at rate control using β-blockers and fluid management (effusion and edema) using furosemide. Transcutaneous electrocardioversion (TCEC) was subsequently conducted under general anesthesia. Successful conversion to normal sinus rhythm was achieved with a single synchronized shock (1.25 J/kg = 100 joules). The wether remained in sinus rhythm with resolution of the CHF at a 2-month follow-up. This is the first report of successful treatment of AF and secondary CHF in a small ruminant using pharmacologic rate control, diuresis, and TCEC. Key clinical message: Management and successful treatment of AF and CHF is possible in small ruminants through intravenous heart rate control and TCEC. Treatment options for heart failure and cardiac disease are limited in ruminants. Further investigations to better understand the pharmacokinetics and dynamics of commonly used cardiac medications in ruminants are warranted.