Background : We have been using an external loop recorder to ascertain the recurrence of atrial fibrillation (AF) because holter recorder is too short for evaluation. Methods : We analyzed the effectiveness of an external loop recorder to evaluate the recurrence of AF in 210 consecutive patients after RFCA between November 2012 and April 2015. The difference in detection rates between the first 24 hours and in 7days as well as the number of the patients with AF recurrence on each day was investigated. Results : AF recurrence in 18 patients (8.6%) in the first 24 hours and 35 patients (16.7%) in 7 days was detected. The number of patients with AF recurrence on each day was 18 in the first, 15 in the second, 13 in the third, 12 in the forth, 10 in the fifth, 15 in the sixth and 13 in the seventh day. Based on these results, AF detection was increased with use of an external loop recorder twice compared to holter recorder. Conclusion : The detection of AF recurrence by an external loop recorder was useful. We should think of useing an external loop recorder too provide better healthcare.
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.
We report the case of a 27-year-old male who had visited our hospital complaining of headache and chest pain during sleep. He had neither a family history of sudden cardiac death nor a past history of syncope and arrhythmias. Twelve-lead ECG showed coved-type ST-segment elevation in the right precordial leads and prominent J wave in the inferior leads. Laboratory tests and echocardiography were normal. He made an emergency visit one month later, presenting cardiac standstill. He died without response to cardiopulmonary resuscitation. Autopsy revealed no gross abnormality. A more detailed pathological evaluation led to some characteristic findings. Bilateral ventricular wall showed irregular thickness with mild myocardial hypertrophy. An epicardial fibrofatty degeneration and myocardial bundle around the vasculature were observed in the left anterior and posterior wall, right wall of the apex, and right ventricular outflow tract. In addition, focal inflammation with multinuclear leukocytes was seen in the epicardium by the right ventricular outflow tract. These findings are consistent with previous autopsy reports for patients with Brugada syndrome.