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Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses

Lara Ibrahim (UGent) , Eva Buschmann (UGent) , Gunther van Loon (UGent) and Pieter Cornillie (UGent)
(2025) EQUINE VETERINARY JOURNAL. 57(1). p.256-264
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Abstract
Background Three-dimensional electro-anatomical mapping, previously performed in horses with atrial arrhythmias, has demonstrated the medial region of the caudal vena cava (CaVC), 1–8 cm caudal to the fossa ovalis, as an anatomical predilection site for atrial tachycardia associated with areas of slow conduction and conduction block. Slow conduction has also been recorded in the cranial vena cava (CrVC). Objectives To investigate the morphological characteristics of the myocardial sleeves (MS) in the CaVC and CrVC, in order to identify a potential substrate of right sided atrial arrhythmias. Study design Cross sectional. Methods Post-mortem dissection of 37 hearts from adult warmblood horses without known cardiovascular disease. Macroscopic examination of the myocardial distribution, evaluated the MS area, length, width, and shape in the CaVC and the CrVC. At least 2 samples from each vena cava MS were histologically examined using Masson's trichrome staining. Results Myocardial sleeves into the medial CaVC and into the CrVC were observed in all horses and showed variations in distribution, shape, and size between horses. Their mean ± standard deviation length from the limbus into the CaVC reached 5.7 ± 1.0 cm (maximum 8.3 cm), and from the azygos vein into the CrVC 5.3 ± 1.6 cm (maximum 8.6 cm). Myocardium-free islands were observed in the CaVC and CrVC in 30% and 6% of horses, respectively. Histologically, MS showed a non-uniform myocardial fibre arrangement, with presence of fibroadipose tissue, features known to result in slow conduction and pro-arrhythmia. Main limitations Study only included horses without history of atrial arrhythmia. Conclusions Myocardial sleeves are present in both CaVC and CrVC, showing anatomical variations between horses. Tissue characteristics known to favour re-entry were identified indicating that these venae cavae MS are a potential substrate for atrial tachyarrhythmias and a target for treatment by ablation.
Keywords
General Medicine, arrhythmia, atrial fibrillation, atrial tachycardia, equine cardiology, myocardial sleeves

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Citation

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MLA
Ibrahim, Lara, et al. “Morphological Evidence of a Potential Arrhythmogenic Substrate in the Caudal and Cranial Vena Cava in Horses.” EQUINE VETERINARY JOURNAL, vol. 57, no. 1, 2025, pp. 256–64, doi:10.1111/evj.14075.
APA
Ibrahim, L., Buschmann, E., van Loon, G., & Cornillie, P. (2025). Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses. EQUINE VETERINARY JOURNAL, 57(1), 256–264. https://doi.org/10.1111/evj.14075
Chicago author-date
Ibrahim, Lara, Eva Buschmann, Gunther van Loon, and Pieter Cornillie. 2025. “Morphological Evidence of a Potential Arrhythmogenic Substrate in the Caudal and Cranial Vena Cava in Horses.” EQUINE VETERINARY JOURNAL 57 (1): 256–64. https://doi.org/10.1111/evj.14075.
Chicago author-date (all authors)
Ibrahim, Lara, Eva Buschmann, Gunther van Loon, and Pieter Cornillie. 2025. “Morphological Evidence of a Potential Arrhythmogenic Substrate in the Caudal and Cranial Vena Cava in Horses.” EQUINE VETERINARY JOURNAL 57 (1): 256–264. doi:10.1111/evj.14075.
Vancouver
1.
Ibrahim L, Buschmann E, van Loon G, Cornillie P. Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses. EQUINE VETERINARY JOURNAL. 2025;57(1):256–64.
IEEE
[1]
L. Ibrahim, E. Buschmann, G. van Loon, and P. Cornillie, “Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses,” EQUINE VETERINARY JOURNAL, vol. 57, no. 1, pp. 256–264, 2025.
@article{01HSB3X8FN513GK1WHV1ZWN654,
  abstract     = {{Background
Three-dimensional electro-anatomical mapping, previously performed in horses with atrial arrhythmias, has demonstrated the medial region of the caudal vena cava (CaVC), 1–8 cm caudal to the fossa ovalis, as an anatomical predilection site for atrial tachycardia associated with areas of slow conduction and conduction block. Slow conduction has also been recorded in the cranial vena cava (CrVC).

Objectives
To investigate the morphological characteristics of the myocardial sleeves (MS) in the CaVC and CrVC, in order to identify a potential substrate of right sided atrial arrhythmias.

Study design
Cross sectional.

Methods
Post-mortem dissection of 37 hearts from adult warmblood horses without known cardiovascular disease. Macroscopic examination of the myocardial distribution, evaluated the MS area, length, width, and shape in the CaVC and the CrVC. At least 2 samples from each vena cava MS were histologically examined using Masson's trichrome staining.

Results
Myocardial sleeves into the medial CaVC and into the CrVC were observed in all horses and showed variations in distribution, shape, and size between horses. Their mean ± standard deviation length from the limbus into the CaVC reached 5.7 ± 1.0 cm (maximum 8.3 cm), and from the azygos vein into the CrVC 5.3 ± 1.6 cm (maximum 8.6 cm). Myocardium-free islands were observed in the CaVC and CrVC in 30% and 6% of horses, respectively. Histologically, MS showed a non-uniform myocardial fibre arrangement, with presence of fibroadipose tissue, features known to result in slow conduction and pro-arrhythmia.

Main limitations
Study only included horses without history of atrial arrhythmia.

Conclusions
Myocardial sleeves are present in both CaVC and CrVC, showing anatomical variations between horses. Tissue characteristics known to favour re-entry were identified indicating that these venae cavae MS are a potential substrate for atrial tachyarrhythmias and a target for treatment by ablation.}},
  author       = {{Ibrahim, Lara and Buschmann, Eva and van Loon, Gunther and Cornillie, Pieter}},
  issn         = {{0425-1644}},
  journal      = {{EQUINE VETERINARY JOURNAL}},
  keywords     = {{General Medicine,arrhythmia,atrial fibrillation,atrial tachycardia,equine cardiology,myocardial sleeves}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{256--264}},
  title        = {{Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses}},
  url          = {{http://doi.org/10.1111/evj.14075}},
  volume       = {{57}},
  year         = {{2025}},
}
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