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A 67-year-old male with dilated cardiomyopathy and chronic renal failure who received chronic hemodialysis for 9 years admitted with pulmonary edema. Three days after admission, electrocardiogram showed transient prolongation of QT interval which was followed by macroscopic T wave alternans (TWA) and ventricular fibrillation (VF). Temporary pacing from right ventricular apex suppressed TWA and VF effectively. Combined cardiac resynchronization therapy and implantable cardioverter defibrillator device was implanted for the secondary prevention of VF. Both prolongation of QT interval and TWA disappeared for 10 days after therapy and no arrhythmic event occurred since then.

Background: Previous studies show that many factors are significantly associated with development and maintenance of atrial fibrillation (AF), however, little is known about the prognosis of the patients who received individually-optimized education to prevent AF recurrence after cardioversion. Method: We chose 37 cases prepared for cardioversion in 142 consecutive patients receiving trans-esophageal echocardiography (TEE) from December 2008 to June 2010. Indication of cardioversion was (1) patient requiring cardioversion because of symptomatic and/or drug refractory AF and (2) patient who wish to restore the heart rhythm to sinus rhythm (SR) by cardioversion. 11 patients (29.7%) were excluded from this study because of intracardiac thrombi. 26 patients were divided into 4 groups by duration of AF: Group 1; within 1 week (2 patients), Group 2