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ID:	53666 Specialists at one of the country’s leading referral vet centres have carried out an incredibly rare and lifesaving second pacemaker operation on a dog.

Eight years ago, North Downs Specialist Referrals (NDSR) in Surrey fitted Ruby, a Yorkshire terrier-Westie cross, with a pacemaker as she had a low heart rate of around 40bpm due to a blockage of the electrical conduction system.

Aged just over three when she was first fitted with the pulse generator, Ruby found herself back at NDSR towards the end of last year, when the specialist vet team at the Linnaeus-owned hospital determined the battery life on her pacemaker was critically low and she required a new device fitting.

Ruby was initially diagnosed with a life-threatening heart problem in 2012. The second device was then fitted at the end of last year.

NDSR’s RCVS and EBVS European specialist in veterinary cardiology, Joao Loureiro, explained: We first met Ruby when she was just three-and-a-half-years-old to investigate her lethargy and slow heart rate.

“We discovered she had a block to the electrical conduction system of her heart, which resulted in no electrical impulses reaching the pumping chambers.

“This meant she had an incredibly low heart rate of just 40 to 50 beats per minute, instead of more than 120, which we would expect.

“She needed a pacemaker fitted which, of course, can be programmed to meet individual requirements.

“The pacemaker lead is usually placed on the inside of the heart via a large vein in the neck and the pulse generator is implanted under the skin of the neck.

“However, weighing only 5kg, Ruby was so small the pulse generator had to be implanted in her abdomen, with the wire sutured to the outside of the heart.”

Due to Ruby’s small size, implantation of the pacemaker and its attachment to Ruby’s heart was a highly technically-demanding procedure that required the skills of NDSR’s RCVS and EBVS European specialist in small animal surgery, Benito de la Puerta.

Joao added: “She made a great recovery and did very well for the ensuing eight years, with no restrictions to her activity or quality of life.

“Ruby had yearly evaluations of her pacemaker and this was found to be working extremely well but recently we discovered the battery had reached a critically low level.

“This was a very serious situation because, if the battery became fully depleted, her heart would stop pumping completely, so surgery was again necessary.

“It’s an unusual procedure in dogs because of their shorter life span and the fact that pacemakers are normally fitted in older animals which don’t then live long enough to see the battery deplete.”

The second procedure was a complete success and with her batteries now recharged, Ruby is back with her family and once again enjoying a new lease of life.

NDSR offers specialist-led services in anaesthesia and analgesia, cardiology, dentistry, dermatology, diagnostic imaging, internal medicine, neurology, oncology, ophthalmology, orthopaedics, soft tissue surgery and spinal surgery.

For more information visit www.ndsr.co.uk or search for North Downs Specialist Referrals on social media.

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ID:	53668Radiographs from NDSR showing Ruby’s initial pacemaker in 2012, left, and her latest procedure, right

Ruby after having a replacement pacemaker fitted by expert vets at North Downs Specialist Referrals, in Surrey