title: Feasibility of early discharge after implantable cardioverter-defibrillator procedures.
abstract: BACKGROUND
  Registry data demonstrate considerably low complication rates after implantable cardioverter-defibrillator (ICD) procedures for primary prevention of sudden death. Yet standard of care includes postimplant overnight in-hospital observation that may levy substantial unnecessary financial burden on health care systems. In appropriate patients, discharge soon after implant could translate into significant cost savings, if such practice does not result in complications. We applied a simple clinical algorithm to assess feasibility of discharge on the same day of ICD implantation in patients at low risk for procedural complications.
  
  
  METHODS
  We prospectively randomized primary prevention ICD candidates at low risk for complications (not pacing-dependent or requiring bridging heparin anticoagulation) to next-day discharge with overnight in-hospital observation, or same-day discharge with remote monitoring for 24 hours after ICD implant. Implants were performed via cephalic vein access, and randomization occurred after 4-hours clinical observation and device interrogation. All patients were followed for a minimum of 6 weeks to assess acute procedural complications.
  
  
  RESULTS
  71 patients comprised the study cohort (mean age 62, 79% male) after 3 were excluded. The most common indication for ICD implant was ischemic cardiomyopathy with ejection fraction ≤35%. Device data obtained through 24-hour remote monitoring was comparable to 4-hour postimplant parameters in same-day discharge patients. No acute complications occurred in same-day discharge patients; 1 next-day discharge patient developed pneumothorax.
  
  
  CONCLUSIONS
  ICD implantation with same-day discharge is reasonable in patients at low risk for complications. Remote monitoring can be useful in indicating lead-parameter stability during the immediate postoperative period.
authors.affiliation: Division of Cardiology, Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA.
authors.forename: Indrajit
authors.initials: I
authors.lastname: Choudhuri
authors.forename: Dipan
authors.initials: D
authors.lastname: Desai
authors.forename: Jon
authors.initials: J
authors.lastname: Walburg
authors.forename: Phyllis
authors.initials: P
authors.lastname: August
authors.forename: Seth I
authors.initials: SI
authors.lastname: Keller
authors.forename: Ranjit
authors.initials: R
authors.lastname: Suri
mesh_terms: D000368:Aged; D000465:Algorithms; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D010351:Patient Discharge; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D013686:Telemetry / Q000295:instrumentation; D013997:Time Factors; D016896:Treatment Outcome