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Pantherophis Guttatus) Edinburgh Research Explorer Standardization of electrocardiographic examination in corn snakes (Pantherophis guttatus) Citation for published version: Lewis, M, Bouvard, J, Eatwell, K & Culshaw, G 2020, 'Standardization of electrocardiographic examination in corn snakes (Pantherophis guttatus)', Veterinary Record. https://doi.org/10.1136/vr.105713 Digital Object Identifier (DOI): 10.1136/vr.105713 Link: Link to publication record in Edinburgh Research Explorer Document Version: Peer reviewed version Published In: Veterinary Record General rights Copyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s) and / or other copyright owners and it is a condition of accessing these publications that users recognise and abide by the legal requirements associated with these rights. Take down policy The University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorer content complies with UK legislation. If you believe that the public display of this file breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 11. Oct. 2021 Veterinary Record Confidential: For Review Only Standardisation of electrocardiographic examination in corn snakes (Pantherophis guttatus) Journal: Veterinary Record Manuscript ID vetrec-2019-105713.R1 Article Type: Original research Date Submitted by the 13-Dec-2019 Author: Complete List of Authors: Lewis, Martyn; the royal (dick) school of veterinary studies, exotics; University of Edinburgh Bouvard, Jonathan; the royal (dick) school of veterinary studies, Cardiology Eatwell, Kevin; Edinburgh University, Royal (Dick) School for Veterinary Studies, Hospital for Small Animals Culshaw, Geoff; Royal (Dick) School of Veterinary Studies, Hospital for Small Animals Introduction: Corn snakes are a very common pet reptile species, yet there is an absence of evidence-based literature standardising collection of electrocardiographs (ECG) or detailing ECG deflection morphology in the normal animal. We describe a well-tolerated, reproducible technique and detail the cardiac cycle in terms of lead 2 equivalent waveforms and intervals. Animals: 29 adult corn snakes. Materials and methods: This prospective study evaluated under species- appropriate, standardised conditions, a technique for producing standard six-lead ECG tracings. Lead 2 equivalent cardiac cycles were described in detail and statistically analysed for gender, weight, length, heart rate Abstract: and mean electrical axis. Results: High-quality tracings demonstrated common ECG characteristics for this species, including: no Q, S or SV waves, prolonged PR and RT intervals, rhythmic oscillation of the baseline, short TP segments and a right displaced mean electrical axis. An influence of gender, weight or length on heart rate and mean electrical axis was not identified. Conclusions: To the authors’ knowledge, this is the first study to describe a standardised technique for recording ECG in significant numbers of normal corn snakes. Ranges have been provided that may be of diagnostic value or form the basis for future development of reference intervals for this species https://mc.manuscriptcentral.com/vetrec Page 1 of 27 Veterinary Record 1 2 3 4 5 6 7 8 9 10 11 Confidential: For Review Only 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/vetrec Veterinary Record Page 2 of 27 1 2 3 The Royal (Dick) School of Veterinary Studies and the Roslin Institute, The 4 University of Edinburgh, Easter Bush Campus, Midlothian, UK EH25 9RG 5 6 7 8 Standardization of electrocardiographic examination in corn snakes (Pantherophis 9 guttatus) 10 11 Martyn Lewis 1 BVM&S, Jonathan Bouvard 2 DVM, Kevin Eatwell1 BVSc (hons) 12 Confidential: For Review Only DZooMed (Reptilian) Dip ECZM (Herpetology and Small Mammals), Geoff J. 13 2 14 Culshaw BVMS, PhD, DVC 15 16 17 1 Dick Vet Rabbit and Exotic Animal Practice, Hospital for Small Animals, Royal 18 (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian, 19 20 UK 2 21 Cardiopulmonary Service, Hospital for Small Animals, Royal (Dick) School of 22 Veterinary Studies, The University of Edinburgh, Roslin, Midlothian, UK 23 24 E-mail for correspondence: [email protected] 25 26 27 28 An abstract containing preliminary results of this study was presented at the 29 International Conference on Avian, Herpetological and Exotic Mammal medicine 30 (iCARE), May 2019, London, UK 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/vetrec Page 3 of 27 Veterinary Record 1 2 3 Abstract 4 5 6 Introduction: Corn snakes are a very common pet reptile species, yet there is an 7 8 absence of evidence-based literature standardising collection of electrocardiographs 9 10 (ECG) or detailing ECG deflection morphology in the normal animal. We describe a 11 12 Confidential: For Review Only well-tolerated, reproducible technique and detail the cardiac cycle in terms of lead 2 13 14 15 equivalent waveforms and intervals. 16 17 Animals: 29 adult corn snakes. 18 19 Materials and methods: This prospective study evaluated under species- 20 21 22 appropriate, standardised conditions, a technique for producing standard six-lead 23 24 ECG tracings. Lead 2 equivalent cardiac cycles were described in detail and 25 26 statistically analysed for gender, weight, length, heart rate and mean electrical axis. 27 28 29 Results: High-quality tracings demonstrated common ECG characteristics for this 30 31 species, including: no Q, S or SV waves, prolonged PR and RT intervals, rhythmic 32 33 oscillation of the baseline, short TP segments and a right displaced mean electrical 34 35 axis. An influence of gender, weight or length on heart rate and mean electrical axis 36 37 38 was not identified. 39 40 Conclusions: To the authors’ knowledge, this is the first study to describe a 41 42 standardised technique for recording ECG in significant numbers of normal corn 43 44 45 snakes. Ranges have been provided that may be of diagnostic value or form the 46 47 basis for future development of reference intervals for this species. 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/vetrec Veterinary Record Page 4 of 27 1 2 3 4 Introduction 5 6 7 Evaluation of cardiac performance and diagnosis of cardiac disease in the ophidian 8 9 patient has historically received little attention, even in captive reptile species, such 10 11 as the corn snake that are common both in private and zoological collections. 12 Confidential: For Review Only 13 14 For captive reptiles poor husbandry is ubiquitous and pervasive, and could 15 16 predispose to cardiac disease either through immunocompromise or 17 18 nutritional/metabolic derangement.1 2 Indeed, both primary and secondary forms of 19 20 21 cardiac disease are widely described in literature and demonstrate the broad 22 23 spectrum of conditions from which snakes may suffer.3-12 Despite this, the 24 25 prevalence of cardiac disease in snakes is unknown, and our understanding of the 26 27 impact of cardiac disease on morbidity and mortality in even very common pet 28 29 30 species, such as corn snakes, is rudimentary in comparison to more familiar 31 32 companion mammals. 33 34 Identification of cardiac disease by both owner and clinician can be very 35 36 37 challenging. The typically sedentary lifestyles and highly restricted captive 38 39 environments of many pet snakes places little demand on the cardiovascular system. 40 41 A low basal metabolic rate and high tolerance for anaerobic respiration means that 42 43 1 13 44 heart disease is usually very far advanced before it becomes clinically apparent. 45 46 Basic cardiac assessment, such as auscultation, has limited value due to poor 47 48 contact between stethoscope and scales. While more advanced investigations, such 49 50 as radiography, electrocardiography (ECG) and echocardiography, suffer from a 51 52 1 13 14 53 paucity of species-specific reference ranges and standardised methodologies. 54 55 In common with other non-crocodilian reptiles, the ophidian heart is a three- 56 57 chambered structure composed of two atria and a single, common ventricle. A 58 59 60 reptile-specific pre-filling chamber, the sinus venosus, is situated caudal to the right https://mc.manuscriptcentral.com/vetrec Page 5 of 27 Veterinary Record 1 2 3 atrium15 and contains spontaneously depolarising pacemaker cells under 4 5 2 16 17 6 vagosympathetic control. There is no sino-atrial node, atrial-ventricular node or 7 8 His/Purkinje network that form the specialised electrical conduction system of higher 9 10 vertebrates, and no annulus fibrosis exists to provide an insulating plane between 11 12 Confidential: For Review Only the atria and ventricle.14 15 Instead a canal or “funnel” of atrioventricular myocardium, 13 14 15 which resembles the ill-defined AV node region of embryonic mammals and birds, 16 17 serves as a conduit for electrical conduction into the ventricle. Despite these 18 19 structural differences, the reptilian ECG waveform is morphologically similar to the 20 21 22 mammalian, with a P wave, QRS complex and T wave representing sequential atrial 23 24 depolarisation, ventricular depolarisation and ventricular repolarisation respectively.1 25 26 13 14 27 28 29 Electrocardiography is widely used in traditional companion mammal species 30 31 to aid evaluation of cardiac health and to monitor cardiac rhythm while under general 32 33 anaesthesia, and should also represent an attractive option for common captive 34 35 snakes to both specialists and general practitioners.
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