Feasibility and safety of same-day discharge after implantable cardioverter defibrillator placement for primary prevention.

BACKGROUND: In the current age of ever-increasing healthcare costs, it is of utmost importance to adopt strategies that reduce hospital stay and cost, while still maintaining patient safety. In this study we review our approach of same-day discharge following implantable cardioverter defibrillator (ICD) placement for primary prevention of sudden cardiac death (SCD). METHODS: We conducted a retrospective chart review of 415 consecutive patients who underwent ICD implantation for prevention of SCD between 2007 and 2010. Patients were divided into an outpatient group (Group A) and an inpatient group (Group B). We evaluated the patients' demographics, comorbidities, and the rate of short-term surgical complications on or before the 2-week follow-up appointment. RESULTS: Of 252 patients included in Group A, 198 (78.6%) were successfully discharged on the same day (Group A1). At the 2-week wound check appointment, four patients (2%) had minor surgical site bleeding, one patient had a hematoma, and one patient developed fever and swelling around the implantation site. Of the Group A patients, 54 (21.4%) were not discharged on the same day (Group A2). A total of 53 patients were included in Group B, four (7.5%) developed a hematoma at the 2-week follow-up wound check visit. CONCLUSIONS: Procedure-related complications after ICD placement are rare. Same-day discharge is safe and feasible following ICD placement for primary prevention of SCD and hence a reduction in healthcare costs can be achieved by decreasing the length of hospital stay.

Status epilepticus secondary to milk-alkali syndrome induced by hypercalcemia (oral antacids).

Milk-alkali syndrome is mainly caused by the ingestion of large amounts of calcium and absorbable alkali. This syndrome can lead to metastatic calcification, renal failure and metabolic alkalosis secondary to hypercalcemia. Hypercalcemia is rarely a cause of seizure activity. Very few case reports have been published linking seizure to hypercalcemia, but only one recent case report about mesial temporal sclerosis relates the seizure activity to Milk-alkali syndrome. This is another report regarding seizure associated with excess calcium carbonate intake, but without any evidence of mesial temporal sclerosis. The patient described in this article, suffered from status epilepticus most likely secondary to hypercalcemia. Evaluations for malignancy, thyroid, and parathyroid dysfunctions were non conclusive, therefore hypercalcemia in our patient was attributed to milk-alkali syndrome given the history of the prolonged calcium carbonate intake.

Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study.

BACKGROUND: Corresponding with a continuing decline in the prevalence of sudden cardiac arrest cases presenting with ventricular fibrillation (VF), there has been a significant rise in the prevalence of pulseless electrical activity (PEA). Given significantly lower survival from PEA versus VF, we comprehensively investigated PEA correlates by incorporating first-responder data with lifetime clinical history information. METHODS AND RESULTS: In the Portland, Ore, metropolitan area (population ≈1 million), cases of out-of-hospital sudden cardiac arrest who underwent attempted resuscitation were identified prospectively (2002-2007). Those presenting with PEA versus VF and asystole were compared with χ² tests, ANOVA, and logistic regression. A total of 1277 cases aged ≥18 years underwent resuscitation by first responders (mean age, 65±16 years; 67% male). Presenting arrhythmia was VF in 48%, PEA in 25%, and asystole/other in the remainder. Compared with VF cases, PEA cases were older (mean age, 68 versus 63 years; P=0.0002), more likely to be female (37% versus 26%; P=0.0008), and less likely to survive to hospital discharge (6% versus 25%; P<0.0001). A history of syncope was strongly associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.3) after adjustment for age, gender, response time, and arrest circumstances. Black race was also independently associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.4). Pulmonary disease and female gender were significant factors associated with PEA (P for interaction=0.04). In a subgroup analysis of resting ECGs (n=391), there were no differences in cardiac clinical history or prevalence of cardiac conduction system disease (PEA, 31.6% versus VF, 32.2%; P=0.48). CONCLUSIONS: PEA cases had a significantly higher prevalence of syncope in their lifetime, with other correlates, including black race, that were distinct from VF cases. Potential mechanistic links between syncope and future manifestation with PEA warrant further exploration.

Epidemiology of sudden cardiac death: clinical and research implications.

The current annual incidence of sudden cardiac death in the United States is likely to be in the range of 180,000 to 250,000 per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the United States during the second half of the 20th century. However, the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the United States and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum, and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.