Cadaver Training for Implantation of Cardiovascular Implantable Electronic Device

Abstract

Background : Cardiologists who implant cardiovascular implantable electronic devices (CIED) should receive operative training and have a detailed knowledge of human anatomy. In other countries, cadaver training has become very common, but, it is not common in Japan. We report the first experience of cadaver training for the implantation of CIED in Japan. Methods : Cadaver training was performed in accordance with the guideline “Autopsy for clinical medicine training and research” and was approved by the institutional research board of Ehime University School of Medicine. Cadavers were embalmed with Thiel solution. We implanted CIED leads (active fixation leads) in cadavers under fluoroscopic guidance. After implantation, we autopsied the cadavers for anatomical evaluation. Results : CIED implantation by the subclavian vein approach could be performed on cadavers. However, cadaver training revealed that atrial lead implantation was difficult because cadavers did not have any spontaneous circulation. After autopsy, important anatomical structures such as the costoclavicular ligaments, phrenic nerves, and arteriovenous vessels could be observed in detail. Common sites for lead perforation included the right atrial appendage, right atrial and ventricular free wall, and right ventricular apex. We compared fluoroscopic images with the true anatomy with respect to lead location, and there were discrepancies between them. Conclusion : Cadaver training is useful for cardiologists who implant CIED to learn about anatomy and operative procedures.