Murmurs and arrhythmias are commonly detected in equine athletes. Assessing the relevance of these cardiovascular abnormalities in the performance horse can be challenging. Determining the impact of a cardiovascular disorder on performance, life expectancy, horse and rider or driver safety relative to the owner's future expectations is paramount. A comprehensive assessment of the cardiovascular abnormality detected is essential to determine its severity and achieve these aims. This consensus statement presents a general approach to the assessment of cardiovascular abnormalities, followed by a discussion of the common murmurs and arrhythmias. The description, diagnosis, evaluation, and prognosis are considered for each cardiovascular abnormality. The recommendations presented herein are based on available literature and a consensus of the panelists. While the majority of horses with cardiovascular abnormalities have a useful performance life, periodic reexaminations are indicated for those with clinically relevant cardiovascular disease. Horses with pulmonary hypertension, CHF, or complex ventricular arrhythmias should not be ridden or driven.

Background: A lack of information on normal heart rhythm at maximal effort hampers investigation of poor performance and sudden death in Standardbred racing.Hypothesis/Objective: To characterize rhythm variations during scheduled racing in clinically normal Standardbred horses. Animals: Two hundred and eighty-eight Standardbred horses competing in 40 scheduled races at a Southern Ontario racetrack. Methods: Observational study, convenience sampling: Heart rhythm was monitored by ECG from harnessing to postrace recovery and assessed visually and by examining heart rate intervals. Rhythm variations were used as response variables in multivariate analysis of race records detailing signalment, race, and race outcome.Results: Monitoring involved 345 individual horse or race events. Occasional, isolated premature cycles, only, occurred during the race. Postrace, sudden cardiac slowing (punctuated deceleration [PD]) appeared in 42 events (12.2%). Only premature ventricular complexes were exhibited in 40 events postrace (11.6%), whereas 55 (15.9%) exhibited complex ventricular arrhythmias (CVA) including torsades-like polymorphic ventricular tachycardia, 34.5% of these being closely associated with PD (odds ratio 5 8). Predispositions to CVA were found for horses parked at the 1/2 mile (odds ratio 5 3), and trotters breaking in the stretch (odds ratio 5 38). Horses spontaneously reverted to sinus rhythm and no sudden death events were encountered.Conclusions and Clinical Importance: Arrhythmias occur frequently in racing Standardbreds during cardiac deceleration, often associated with sudden, rapid increases in vagal tone. Circumstances imposing unusual demand and racing at the trot appear to predispose. Findings provide insight into possible mechanisms of sudden death.

Background: Transvenous electrical cardioversion (TVEC) has been developed for treatment of atrial fibrillation (AF) in horses. The relationship among patient variables, treatment response, and outcome in a typical referral population has not been evaluated.Hypothesis: Patient variables such as age, sex, weight, and duration of arrhythmia affect prognosis for response to treatment and the energy level at which cardioversion occurs.Animals: TVEC was applied to 72 episodes of lone AF in 63 client-owned performance horses, with the majority (54) being Standardbred racehorses.Methods: Catheterization of the right atrium (RA) and pulmonary artery (PA) through the jugular vein was used for electrode placement before horses were placed under general anesthesia. Biphasic, truncated exponential shock waves were delivered at incremental energy levels until cardioversion was achieved or a maximum single-energy level of 300 J was reached (cumulative energy 50-1,960 J). A multivariate model was constructed to evaluate influence of patient factors on cardioversion energy.Results: Cardioversion was achieved in 71 of 72 episodes (62 of 63 horses) at a mean energy of 165.43 AE 8.75 J. Cardioversion energy was higher for females than for males, and for interaction terms, weight was negatively related to energy in females and positively related in males. Age was positively related to cardioversion energy in females. No relationship was identified between duration of arrhythmia before treatment and prognosis for response or cardioversion energy.Conclusions and Clinical Importance: TVEC is highly effective in the treatment of lone AF in horses. Although age and sex influence cardioversion energy level, duration of arrhythmia does not.

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Atrial fibrillation is the most common performance-limiting arrhythmia in the horse. Detailed cardiovascular evaluation will help guide prognosis and treatment. Many affected horses have lone atrial fibrillation (no predisposing cardiac abnormalities). These horses have a good prognosis for return to performance if sinus rhythm can be restored. The main therapeutic option continues to be quinidine, which has been used for over 60 years. Transvenous electrical cardioversion has proven to be a successful alternative. Other therapeutic options are being explored, but are currently limited.