QT Interval and Cardiac Restitution Ratio Complexity in Standardbred Racehorses From Rest to Maximal Effort: Insights Into Arrhythmia Risk

Abstract

Background: Sudden cardiac death is common in racehorses. Factors associated with the QT interval that could predispose to fatal cardiac arrhythmias are unknown. Cardiac restitution, expressed as a ratio of QT/TQ, has been used in humans to assess arrhythmia risk but has not been described in horses during maximal intensity exercise. Hypothesis/Objective: Describe factors associated with the QT interval and cardiac restitution ratio (CRR) in clinically normal Standardbred racehorses under race-day conditions. Animals: Archival electrocardiograms from 42 Standardbred horses during live racing in Ontario. Methods: Observational study performing an automated cardiac restitution analysis. Cardiac cycles were obtained from rest, non-race exercise, non-race recovery, live racing, and post-race recovery periods. Multivariable linear regression analysis was performed with both QT interval and CRR as outcomes of interest. Results: Analysis of 3827 sequential pairs of cardiac cycles was performed. Exercise period and RR interval were highly associated with both QT interval and CRR. Other significant associations varied by exercise period and included: racing gait, sex, age, whether the horse received furosemide, and whether the horse experienced complex ventricular arrhythmias after racing. Interactions between gait and furosemide, and sex and gait were also significant. Conclusions and Clinical Importance: An automated cardiac restitution analysis is feasible in exercising racehorses. The QT-RR interval relationship is multifactorial, and there are numerous significant associations that must be considered to interpret changes in QT interval and CRR in horses.