Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test

Sanni Hansen*, Nina D. Otten, Sarah D. Nissen, Helena Carstensen, Charlotte Hopster-Iversen, Julie Fjeldborg, Sophie H. Staun, Merle Fenner, Eva M. Hesselkilde, Rikke Buhl

*Corresponding author af dette arbejde

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Abstract

Background: Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. Objective: To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. Study design: Two-arm controlled experiment. Methods: Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25–44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including tracheal wash and bronchoalveolar lavage (BAL), was performed 48–72 h before and 24 h after the two SETs. In addition, endoscopic grading of tracheal blood was performed 2 h after each SET. Results: After SET1, none of the horses showed blood in the trachea, and two horses showed erythrophagocytosis. Following SET2, two horses had grade 1 blood in the trachea and free erythrocytes and erythrophagocytosis in the BAL, while another two horses had erythrophagocytosis in the BAL. In SET2, the overall performance on the treadmill was decreased with a lower maximum velocity (SET1 10.3 ± 0.8 m/s vs. SET2 8.9 ± 0.9 m/s, p = 0.004), a higher heart rate (284 ± 21 vs. 221 ± 18 bpm, p = 0.003) and more abnormal QRS complexes (p < 0.001) compared with SET1. Conclusions: Two horses showed signs of EIPH, resulting in visible blood in the trachea, when exercising in AF compared with SR. However, a possible link between EIPH, pulmonary pressure and AF needs to be further elucidated.

OriginalsprogEngelsk
TidsskriftEquine Veterinary Journal
Vol/bind56
Udgave nummer3
Sider (fra-til)552-561
ISSN0425-1644
DOI
StatusUdgivet - 2024

Bibliografisk note

Funding Information:
The authors thank Bent Mack‐Hansen, Henrik Kildeberg and Peter Urban for their assistance with the treadmill tests, Stine Østergaard and Mogens Teken Christophersen for performing the lameness evaluation of the horses and Stefan Sattler and Jacob Tfelt‐Hansen for implanting the pacemakers in the horses. The study was generously funded by the Brdr. Hartmann Foundation, the Augustinus Foundation and Kustos Foundation. Merle Fenner was funded by the European Union's Horizon 2020 MSCA ITN under Grant Agreement No. 675351.

Publisher Copyright:
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.

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