J . small Anim. Pract. (1979) 20,5741.

A case of suspected ventricular pre-excitation

in the cat
P. A. F L E C K N E L L , * t T. J. G RUF F YDD-JONES ,* C. M.
BROWN*$ A N D D. F. KELLY9
* Department of Veterinary Medicine, Langford House, Langford, Bristol BS 18 7DU and
Q Department of Pathology, The Medical School, University of Bristol

ABSTRACT
The electrocardiographic findings are described in a cat with suspected
ventricular pre-excitation suggestive of the Lown-Ganong-Levine syn-
drome and their relevance to the clinical picture are discussed.

I N T RO D U CTION
In the normal electrocardiograph (ECG) the P wave, representing depolarization
of the atria, is separated from the QRS complex, ventricular depolarization, by a
P-R interval (Fig. 1). The duration of the P-R interval is determined mainly by
the delay of the sinus impulse as it passes through the A-V node from the atria to
the ventricles. This delay ensures that ventricular contraction follows atrial
contraction at the optimum time for haemodynamic efficiency. If, for any reason,
the impulse is not delayed at the A-V node then the ventricles will be depolarized
prematurely and the P-R interval will be shortened. This abnormal pre-excitation
of the ventricles occurs in man and is often associated with other electrocardio-
graphic findings. The two major syndromes recognized in man are the Wolff-Par-
kinson-White syndrome (WPW), and the Lown-Ganong-Levine syndrome
(LGL) (Green, 1976). WPW is characterized by a shortened P-R interval, a delta
wave or slurring of the initial part of the QRS, and a history of paroxysmal
t Present address: Division of Comparative Medicine, Clinical Research Centre, Watford Road,
Harrow, Middlesex, HA1 3UJ.
$ Present address: Department of Veterinary Medicine and Surgery, Washington State Univer-
sity, Pullman, Washington, 99164, U.S.A.
002M510/79/0100-0057$02.00 01979 BSAVA
57
58 P. A . F L E C K N E L L et al.

tachycardia (Greene, 1976). The ECG in LGL is similar to WPW except that
there are no delta waves and the QRS is normal (Greene, 1976). Both syndromes
can be explained by the presence of accessory conduction pathways which bypass
the A-V node. These conduct the impulse more rapidly from the atria to the
ventricles thus shortening the P-R interval. Such pathways have been demon-
strated in man (Longo & Kindred, 1975).
Although ventricular pre-excitation has been reported in horses, cattle and
dogs (see Ogburn, I977 for references), it has only been occasionally reported in
the cat. Tilley & Lord (1977) mention one case of WPW in a series of cats with
cardiomyopathy and thromboembolism, and Ogburn ( 1977) described a single
detailed case together with a consideration of the aetiology of the syndrome.
This report describes the clinical and electrocardiographic findings in a cat with
possible ventricular pre-excitation similar to that of the LGL syndrome in man.

7-------- -Y-------- y----- @

FIG.1. Electrocardiographic recording from a normal cat. Lead 11, paper speed 5 cmjsec
(Curvilinear recording, r = 1 1 cm).

------ I---'-----Y li
1 - 1

FIG.2. Electrocardiographic recording from a case of suspected ventricular pre-exci-

tation. (Note shortening of P-R interval). Lead 11, paper speed 5 cm/sec (Curvilinear
recording, r = 1 1 cm).

CASE HISTORY
The cat was a 7-year-old neutered male Russian Blue. It was referred with a .
 V E N T R I C U L A R P R E - E X C I T A T I O N IN T H E C A T 59
3-week history of dyspnoea associated with accumulation of thoracic fluid.
Removal of the thoracic fluid by thoracentesis and diuresis had produced only
temporary improvement.
The cat was in poor bodily condition and markedly dyspnoeic. Rectal tempera-
ture was normal and the pulse rate was 180. The presence of excess thoracic fluid,
detected by auscultation and percussion, was confirmed by radiographic exam-
ination and 300 ml of thin, blood-stained fluid was withdrawn by thoracentesis.
The fluid was low in protein (19 g/l) and contained leucocytes and reactive
mesothelial cells (4.5 x 103/mm3).The haemogram, plasma proteins and blood
urea were within normal limits. The white blood cell count was high (31.4 x lo3
/mm3 with a left shift (70% neutrophils, 5% band forms). Radiographs showed a
slight enlargement of the cardiac shadow. Administration of diuretics (frusemide
Lasix-Hoechst), antibiotics (ampicillin Penbritin-Beechams) and intravenous
fluids, produced a temporary improvement in condition, but the cat relapsed
whilst still under treatment and euthanasia was carried out.

E L E CT RO CA RD I O G RA PHIC F I N D I N G S
A standard limb lead system was used for all ECG recordings with the cat
positioned in sternal recumbency. The initial recordings made on the day of
admission were difficult to interpret due to severe baseline noise caused by muscle
tremor and body movement resulting from the dyspnoea. Measurements made
on subsequent recordings taken with lead I1 (Fig. 2) showed a heart rate of 180,
P-R interval of 45 msec, and QRS complex of 37-msec duration. There was no
recognizable isoelectric period between the end of the P wave and the onset of the
Q wave. The presence of a short P-R interval with a normal duration of the QRS
complex indicated ventricular pre-excitation of the Lown-Ganong-Levine type.

POST M O R T E M F I N D I N G S
Gross post mortem examination showed a small recent fibrinous pericardial
adhesion, left atrial dilation, renal polar scars and enlargement of the left thyroid
gland. The heart weighed 21.1 g Microscopic renal abnormalities included inter-
stitial amyloidosis and tubular degeneration. In the thyroid there was an
adenoma and interstitial amyloidosis. Serial sections were cut through the medial
and lateral walls of the right atrium: no histological abnormalities were recog-
nized in the conduction system and the myocardium was normal, apart from the
presence of occasional small foci of lymphocytes.

DISCUSSION
There have been few reports of conduction disturbances of the heart in the cat and
60 P. A . FLECKNELL et al.
little is known of their significance. Tilley & Lord (1977) found eight cats with
conduction disturbances in a series of thirty-four with cardiomyppathy. These
included four with left anterior hemiblock, and one each with left bundle branch
block, atrio-ventricular dissociation, and ventricular pre-excitation typical of
WPW. The only other report of ventricular pre-excitation in the cat is the detailed
description of a case of WPW by Ogburn ( 1 977).
The normal P-R interval in the cat is 74 msec (range 55-100 msec) and the
duration of the normal QRS complex is 36 msec (range 2 0 4 5 msec) (Rogers &
Bishop, 1971). In the present case, as in the case of WPW reported by Ogburn
(1977), the P-R interval was shorter than normal at 45 msec. However the
duration of the QRS complex in the present case was normal at 34 msec, whereas
in the case of WPW described by Ogburn (1977) this interval was prolonged to 70
msec. The abnormally short P-R interval and the normal QRS duration support
the diagnosis of LGL (Greene, 1976). In this syndrome there are thought to be
pathways which bypass the A-V node and these conduct the sinus impulse more
rapidly from the atrium to the His bundle than if it were conducted normally via
the A-V node (Greene, 1976). In man some cases of WPW and LGL have a
history of paroxysmal tachycardia (Greene, 1976; Longo & Kindred, 1975), and
there were supraventricular arrhythmias in the cat reported by Ogburn (1 977).
No arrhythmia was recognized on the recordings taken from the present case.
Although the heart rate was very high the nature of the tachycardia was not
determined.
The significance of such conduction disturbances in the cat is not known. The
enlargement of the heart, recognized radiographically and at post mortem
examination, suggest that cardiac disease accounted for the accumulation of
thoracic fluid, although there was no convincing anatomical cause of cardiac
failure. Thin, clear thoracic fluids with characteristics of a transudate have always
been associated with cardiac disease in previous cases seen by the authors
(Gruffydd-Jones & Flecknell, 1978). It is uncertain whether the pre-excitation
contributed to the cardiac disease or was an incidental finding. In man the
condition is not necessarily indicative of clinical cardiac disease but may be
associated with arrhythmias and tachycardia (Greene, 1976). The cat described in
the paper showed no evidence of arrhythmia in contrast to the case described by
Ogburn (1 977) which was initially presented with an arrhythmia although this
was not associated with cardiac failure. It is possible, in the present case, that the
lack of a reasonable pause between atrial contraction and the onset of ventricular
contraction could have resulted in decreased ventricular filling and reduced
cardiac efficiency, leading to cardiac failure and hence the pleural effusion.
The relationship of the renal changes to the clinical picture is unclear. The
tubular degeneration may have resulted from reduced renal perfusion caused by
cardiac failure. Hypokalaemia, which may result from prolonged diuresis with
frusemide, may contribute to this problem, but in this case a single estimation of
plasma potassium was within normal limits. The thyroid changes are considered
 V E N T R I C U L A R P R E - E X C I T A T I O N IN THE C A T 61
to be coincidental lesions unrelated to the cardiac changes: amyloidosis and
adenoma of the thyroid both occur as clinically silent senile changes.

ACKNOWLEDGMENTS

The authors wish to thank Dr C. Gibbs of the Department of Veterinary Surgery,

University of Bristol for radiological interpretation, and Mr D. R. Lane of
Leamington Spa for referring the cat.

REFERENCES
GREENE, H.L. (1976) Accessory atrioventricular conduction syndromes: a review. John Hopkins
Med. JI. 139, 13.
GRUFFYDD-JONES, T.J. & FLECKNELL, P.A.F. (1 978) The treatment and prognosis in relation to the
gross appearance and laboratory characteristics of pathological thoracic fluids in the cat. J. small
Anim. Pract. 19,315.
LONGO,M.R. & KINDRED, J.A. (1975) Wolff-Parkinson-White syndrome revisited: a review.
Military Med. 140, 325-8.
OGBURN, P.N. (1977) Ventricular pre-excitation (Wolff-Parkinson-White Syndrome) in a cat. J .
Am. Anim. Hosp. Ass. 13, 171.
ROGERS, W.A. &BISHOP, S.P. (1971) Electrocardiographic parameters of the normal domesticcat: a
comparison of standard limb leads and an orthogonal system. J . Electrocardiol. 4,315.
TILLEY, B.M. & LORD,P.F. (1977) Primary myocardial disease in the cat. Am. J . Path. 87,493.