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Clinical decision making
Is treatment with pimobendan associated with an increased risk of arrhythmias in dogs with heart disease?
  1. S. Hillyer,
  2. R. Tedford,
  3. S. Partridge,
  4. E. Cooper,
  5. M.J. Hezzell and
  6. E. Place
  1. University of Bristol, Bristol, UK

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Clinical scenario

Pimobendan is a positive inotrope and balanced vasodilator via its actions as a calcium sensitiser and phosphodiesterase III inhibitor, respectively.1 There is strong evidence for its use in the treatment of dogs with congestive heart failure (CHF), with multiple clinical trials demonstrating a resultant increase in survival time.2-5 However, the use of pimobendan for treatment of heart disease in people has been associated with increased risk of arrhythmias.6 This effect is attributed to the racemic nature of pimobendan resulting in D and L chiral enantiomers, with the L-optical isomer having a significantly greater calcium sensitising effect.7-9 There is limited data available regarding any effect of treatment with pimobendan on the risk of arrhythmias in dogs. The aim of this article is to analyse the available data to determine whether evidenced-based conclusions can be drawn.

The question

In [dogs with cardiac disease] does treatment with [pimobendan] compared to [alternative treatments OR placebo] lead to [increased risk of arrhythmias]?

Search strategy

The search strategy is available as a supplement to this article on Vet Record’s website at

Supplementary file 1


Search outcome

  • Ten papers found in Medline search

  • One was excluded because it was a duplicate

  • Eight were excluded because they did not answer the question

  • One relevant paper was identified from Medline

  • Eighteen papers found in CAB search

  • Sixteen papers were excluded as they did not answer the question

  • Two relevant papers were identified from CAB Abstracts

  • Four papers were identified from other sources

  • Six relevant papers from Medline, CAB Abstracts and additional sources

Search last performed: 31 May, 2018

Summary of evidence

Paper 1: Effect of pimobendan on the incidence of arrhythmias in small breed dogs with myxomatous mitral valve degeneration (MMVD)10

Patient group: Eight client-owned small breed dogs (<15 kg) with CHF due to MMVD. Four dogs received placebo and four received pimobendan.

Study type: …

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