Masahiko Satoda

Acute myocardial infarction caused by spontaneous postpartum coronary artery dissection.

Background A 34-year-old postpartum woman presented at hospital with chest pain. She had experienced an uneventful delivery of a healthy infant and had no known coronary risk factors. Electrocardiography demonstrated an acute myocardial infarction, which resolved on intravenous glyceryl trinitrate infusion. Coronary angiography revealed diffuse narrowing of the left anterior descending artery and tapering of the left main trunk, but there were no obvious hallmarks of intimal dissection.Investigations Electrocardiography, coronary angiography, multidetector CT and intravascular ultrasonography.Diagnosis Postpartum coronary artery dissection.Management The lesion was stabilized with orally administered amlodipine, aspirin, ticlopidine and pitavastatin, along with intravenous heparin and glyceryl trinitrate. The patient was later discharged on bisoprolol, aspirin, pitavastatin and temocapril.

Asymptomatic Brugada syndrome associated with postural orthostatic tachycardia syndrome: Does autonomic disorder increase propensity for future arrhythmic events?

Autonomic imbalance may work as a modifying factor for initiating lethal arrhythmia in patients with Brugada syndrome. A 26‐year‐old man with episodes of near syncope was given a diagnosis of an autonomic disorder, postural orthostatic tachycardia syndrome (POTS). The patient spontaneously showed typical Brugada‐type ECG, and ventricular fibrillation was induced by programmed electrical stimulation, which allowed the further diagnosis of Brugada syndrome. Although it seems that Brugada syndrome is asymptomatic, its uncommon association of POTS may increase the risk for future arrhythmic events in this patient. (PACE 2004; 27:537–540)

Novel Technique to Facilitate Defibrillator Lead Implantation via Cephalic Vein Cutdown by Means of a Reference Catheter and a Specially Designed Long Sheath

The cephalic vein is recommended as the access route for an implantable cardioverter defibrillator lead to avoid complications associated with subclavian vein puncture; however, cephalic vein cutdown is not necessarily preferred, mainly because of procedural complexity. To facilitate cephalic vein cutdown, we have devised the following method. An 8 Fr catheter is placed in the cephalic vein over a guidewire inserted percutaneously from the left peripheral cephalic vein. The catheter, which is palpable beneath the skin prior to incision, indicates the location of the cephalic vein, facilitating its isolation. A specially designed 9 Fr tear‐away sheath‐dilator unit is used to place leads. With its long‐tapered and curved tip, the unit is easy to insert, even when the cephalic vein is stenotic or tortuous. The 30‐cm‐long sheath reaches the right atrium, and thus the lead is advanced directly to the right atrium without risk of vascular injury. This technique may be feasible in the majority of patients and can even be used by inexperienced implanters.

Restoring the Recurrent Extrusion of the Subcutaneously Implanted Defibrillator by Means of Subpectoral Replacement: The Benefits of Subpectoral Implantation in the Current ICD Era

A 72‐year‐old man with a thin build had an ICD system with a generator implanted at left prepectoral space. The generator was exposed through thin overlying skin at 11 months following surgery. Although it was undermined with the adjacent skin, it was exposed again 6 months later. The generator was replaced in the ipsilateral subpectoral space. Since then, no signs of recurrence have been observed for the subsequent 12 months, with the patient pleased with its cosmetic appearance. This case illustrates the benefits of subpectoral implantation in the current ICD era in which subcutaneous implantation is common.