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. 2016 Jan-Feb;30(1):51-7.
doi: 10.1111/jvim.13800. Epub 2015 Dec 17.

Atrial Fibrillation as a Prognostic Indicator in Medium to Large-Sized Dogs with Myxomatous Mitral Valvular Degeneration and Congestive Heart Failure

S W Jung  1 , W Sun  2 , L G Griffiths  3 , M D Kittleson  3
Affiliations

Atrial Fibrillation as a Prognostic Indicator in Medium to Large-Sized Dogs with Myxomatous Mitral Valvular Degeneration and Congestive Heart Failure

S W Jung et al. J Vet Intern Med. 2016 Jan-Feb.

Abstract

Background: The prevalence and prognostic importance of atrial fibrillation (AF) on survival in nonsmall breed dogs with myxomatous mitral valvular disease (MMVD) and congestive heart failure (CHF) remain unknown.

Aim: To identify the prevalence of AF in nonsmall breed dogs with CHF because of MMVD and to characterize the impact of AF on survival outcome.

Animal: Sixty-four client-owned dogs (>15 kg) with MMVD and CHF.

Methods: Retrospective review of medical records for dogs weighing >15 kg with MMVD treated for CHF.

Results: Thirty-three dogs presented with AF or developed AF during follow-up examinations, and 31 dogs were free of AF until cardiac-related death. For dogs with AF, median survival time (MST) was 142 days (range: 9-478) while dogs without AF lived 234 days (range: 13-879 days). AF increased risk of cardiac-related death (HR = 2.544; 95% CI = 1.41-4.59; P = .0019) when compared to dogs without AF. MST was significantly prolonged for dogs with AF whose rates were adequately controlled (<160 bpm; 171 days; n = 13) when compared to dogs that failed to respond to negative chronotropic agents (61 days; n = 20; P = .032). The administration of combination treatment (diltiazem and digoxin) significantly decreased median HR to 144 bpm (range: 84-218 bpm) in dogs with AF and significantly prolonged MST (diltiazem+digoxin: 130 days versus diltiazem: 35 days, P = .0241) when compared to diltiazem alone.

Conclusions and clinical importance: Inadequately controlled AF is associated with a higher rate of mortality. Optimization of therapeutic strategies for the rate control of AF remains determined.

Keywords: Atrial fibrillation; Congestive heart failure; Myxomatous valvular disease; Prognosis.

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Figures

Figure 1
Figure 1
Kaplan–Meier survival statistics of dogs with or without AF. Dogs without AF had a significantly longer median survival time (MST) compared with dogs with AF (MST of No AF = 234 days versus AF = 142 days, P = .002).
Figure 2
Figure 2
Kaplan–Meier survival curve of dogs with (<160 bpm) and without (>160 bpm) adequate rate control of AF. Dogs with adequate rate control showed a significantly longer median survival time compared to dogs with inadequate rate control (<160 bpm: 171 days versus >160 bpm: 61 days, P = .032).
Figure 3
Figure 3
Kaplan–Meier survival curve of dogs with and without digoxin for AF heart rate control. Dogs administered diltiazem plus digoxin had a significantly longer median survival time compared with dogs not administered digoxin (diltiazem+digoxin: 130 days versus diltiazem: 35 days, P = .024).
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