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ABSTRACT: Electroconvulsive therapy (ECT) is considered the gold standard treatment for many psychiatric illnesses; however, it is not without risk. There have been no systematic reviews to date on new-onset atrial fibrillation following ECT. Thus, the aim of this study is to identify reported occurrences of new-onset atrial fibrillation following ECT and the ability to safely resume ECT thereafter.A case pertaining to the development of atrial fibrillation after ECT in a young healthy male is presented. In addition, a systematic review of the literature pertaining to atrial fibrillation after ECT was conducted through PubMed, PsycInfo, and EMBASE. Of the 233 articles screened, 15 articles were selected for in-depth review. Of the 15 articles, only 10 articles met inclusion criteria. These articles included 9 case reports and 1 retrospective review. The retrospective review included 1 patient that developed atrial fibrillation out of 13 patients receiving ECT at the site. The 10 patients included varied in age, risk factors, type of ECT conducted, and treatment of the atrial fibrillation. Of the 4 articles that discussed outcomes, all patients were able to return to ECT without further complications.There are many potential reasons ECT may induce atrial fibrillation, and there are additional treatment considerations for atrial fibrillation in patients receiving ECT. Notably, our results indicate that many have been able to continue ECT without further complications; however, more research is needed to identify the frequency of this adverse reaction.
RESUMEN
OBJECTIVE: Although disparities have been described in epilepsy care, their contribution to status epilepticus (SE) and associated outcomes remains understudied. METHODS: We used the 2010-2019 National Inpatient Sample to identify SE hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM codes. SE prevalence was stratified by demographics. Logistic regression was used to assess factors associated with electroencephalographic (EEG) monitoring, intubation, tracheostomy, gastrostomy, and mortality. RESULTS: There were 486 861 SE hospitalizations (2010-2019), primarily at urban teaching hospitals (71.3%). SE prevalence per 10 000 admissions was 27.3 for non-Hispanic (NH)-Blacks, 16.1 for NH-Others, 15.8 for Hispanics, and 13.7 for NH-Whites (p < .01). SE prevalence was higher in the lowest (18.7) compared to highest income quartile (18.7 vs. 14, p < .01). Older age was associated with intubation, tracheostomy, gastrostomy, and in-hospital mortality. Those ≥80 years old had the highest odds of intubation (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.43-1.58), tracheostomy (OR = 2, 95% CI = 1.75-2.27), gastrostomy (OR = 3.37, 95% CI = 2.97-3.83), and in-hospital mortality (OR = 6.51, 95% CI = 5.95-7.13). Minority populations (NH-Black, NH-Other, and Hispanic) had higher odds of tracheostomy and gastrostomy compared to NH-White populations. NH-Black people had the highest odds of tracheostomy (OR = 1.7, 95% CI = 1.57-1.86) and gastrostomy (OR = 1.78, 95% CI = 1.65-1.92). The odds of receiving EEG monitoring rose progressively with higher income quartile (OR = 1.47, 95% CI = 1.34-1.62 for the highest income quartile) and was higher for those in urban teaching compared to rural hospitals (OR = 12.72, 95% CI = 8.92-18.14). Odds of mortality were lower (compared to NH-Whites) in NH-Blacks (OR = .71, 95% CI = .67-.75), Hispanics (OR = .82, 95% CI = .76-.89), and those in the highest income quartiles (OR = .9, 95% CI = .84-.97). SIGNIFICANCE: Disparities exist in SE prevalence, tracheostomy, and gastrostomy utilization across age, race/ethnicity, and income. Older age and lower income are also associated with mortality. Access to EEG monitoring is modulated by income and urban teaching hospital status. Older adults, racial/ethnic minorities, and populations of lower income or rural location may represent vulnerable populations meriting increased attention to improve health outcomes and reduce disparities.
