Ability of Surface Electrocardiography in Predicting Ventricular Arrhythmias in Dogs with Secondary Atrial Fibrillation

Atrial fibrillation (AF) and ventricular arrhythmias (VAs) are common pathological arrhythmias of dogs and are both associated with a poor prognosis in those with cardiac disease. This study aimed to assess the ability of 2 to 5 min electrocardiography (routine ECG) to detect the presence and severity of concomitant VAs in dogs with secondary AF. Continuous 24 h ECG monitoring (Holter) was used as the reference standard to identify VAs, quantify the number of premature ventricular ectopic complexes (VPCs) and evaluate the degree of their organization using a modified Lown-Wolf classification scale. In light of the Holter findings, VAs were classified as severe based on two criteria: the presence of more than 100 VPCs and a Lown-Wolf grade ≥ 4. Thirty-five dogs with secondary AF were included, where all exhibited VAs on Holter monitoring. Most dogs had severe VAs, according to both the VPC count (69%) and Lown-Wolf classification (77%). However, only 13 dogs (37%) had VAs detectable on routine ECG. A significant positive correlation was found between the presence of VAs on routine ECG and the severity of VAs identified via Holter. Nevertheless, the diagnostic accuracy of routine ECG in predicting severe VAs was only moderate (68.6% based on VPC count and 60% based on Lown-Wolf grade). Overall, a 2 to 5 min ECG appears to be a highly specific but relatively insensitive tool for detecting VAs in dogs with secondary AF.