Early recognition with capnography, and successful resuscitation, of severe cardiac dysfunction during transvenous electric cardioversion (TVEC) in a horse

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.