Early recognition with capnography, and successful resuscitation, of
severe cardiac dysfunction during transvenous electric cardioversion
(TVEC) in a horse
Abstract
A 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
Joules) and sinus rhythm was temporarily restored. After 13 seconds, AF
recurred so a fourth shock (300 Joules) 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, amongst 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. It also emphasises the critical importance of early
recognition and communication of complications within anaesthetic and
cardiology teams.