Termination of electrocution-induced ventricular fibrillation by an implantable cardioverter defibrillator.

We describe a case in which an implantable cardioverter defibrillator (ICD) saved a patient's life after he tried to commit suicide by electrocuting himself. Deaths caused by electrocution are usually accidental and rarely suicidal. The amount of current flow is the most important factor in deciding the degree of electrical injury, which may range from transient muscle tremors to death. The ICD is electrically insulated from surrounding electromagnetic interference and the passage of electric current typically does not damage or reprogram the device. In our patient, electromagnetic interference caused by the electric current initially triggered the noise reversion mode, leading to asynchronous pacing. Ventricular fibrillation was detected and terminated only after the electromagnetic interference stopped, as depicted by the intracardiac electrogram. This case is the first documented example of an ICD-aborted fatal electrocution from ventricular fibrillation caused by an unnatural electrical source. (PACE 2010; 510-512).

Metformin-induced cholangiohepatitis.

Drug-induced cholangiohepatitis accounts for 20-50% of non-viral chronic hepatitis cases. Metformin is the most commonly prescribed oral anti-diabetic drug from the biguanide class used in treatment of overweight and obese type 2 diabetes mellitus patients. Metformin-induced cholangiohepatitis with marked elevations in serum liver transaminases and intrahepatic cholestasis has been infrequently reported. Here, we report a case of acute cholangiohepatitis after initiation of metformin treatment.