Effect of electroconvulsive therapy on cardiac rhythm, conduction and repolarization

Corrected QT interval changes during electroconvulsive therapy-antidepressants-atypical antipsychotics coadministration: safety issues

Both old and newer antidepressants and some atypical antipsychotics, such as ziprasidone and quetiapine, used as augmentation agents in severe major depression, are known to increase corrected QT (QTc) interval. We investigated the safety of the coadministration of electroconvulsive therapy with an antidepressant-ziprasidone-quetiapine combination with respect to QTc interval in 6 female patients with severe major depression resistant to pharmacotherapy alone. Each patient underwent a series of 10 to 11 sessions of bilateral electroconvulsive therapy. Corrected QT intervals were calculated at baseline and several times up to 10 minutes after seizure cessation. Overall, QTc interval changes remained within normal limits, without the occurrence of any cardiac adverse events. Our findings suggest that the coadministration of these treatments might be safe, at least with respect to QTc interval changes.

Lack of effect of ECT on Holter monitor recordings before and after treatment

OBJECTIVE

There has been concern about persisting cardiac effects of electroconvulsive therapy (ECT). Several studies have analyzed Holter monitor recordings before and after ECT, and generally have found no significant effects.

METHODS

As part of a study on heart rate variability changes in ECT, we performed 2-3 hour Holter monitoring before and at least 1 hour after courses of ECT in 11 depressed patients without cardiac illness.

RESULTS

There was no significant difference before and after Ect in heart rate, frequency ofventricular or supraventricular events, or in ST segments.

CONCLUSION

These date provide further evidnece of the general cardiac safety of ECT.

Cardiac arrhythmias induced by ECT in elderly psychiatric patients: experience with 48-hour Holter monitoring

Serious adverse events associated with electroconvulsive therapy (ECT) are uncommon and consist mostly of cardiovascular complications, mainly arrhythmias. The risk of complications is increased in elderly and physically ill patients. In the current study, a 24-hour pre-ECT and 24-hour post-ECT Holter recording was performed on 26 elderly patients during their first ECT treatment. ECT caused a significant increase in bigeminy/trigeminy and supraventricular tachycardia, but did not increase other arrhythmias. Pre-ECT arrhythmias correlated with post-ECT arrhythmias. All patients in the current study completed the ECT course. Thus, the clinical significance of arrhythmias remains uncertain. The present findings support the usual practice of continuous electrocardiogram monitoring during ECT and recovery.

Acute effects of ECT on cardiovascular functioning: relations to patient and treatment variables

In 34 patients with primary, major depressive disorder, randomly assigned to bilateral or right unilateral ECT, heart rate (HR) and blood pressure (BP) were assessed prior and following seizure induction at every treatment. In contrast to prior reports, no cumulative pattern was observed in HR or BP changes as a function of treatment number. Generally, treatment variables, including ECT modality (bilateral vs. unilateral), anesthetic agent (methohexital vs. pentothal), and prior subconvulsive stimulation in a session, had no effects on the magnitude of peak postictal increases in HR or BP. The peak changes were also unrelated to the history of cardiac illness, remission of depressive symptomatology, patient seizure threshold and patient seizure duration. Pre-treatment HR was strongly predictive of peak postictal change in both HR and BP, while pretreatment BP was not. Patients with high pre-ECT HR had smaller peak postictal HR and BP increases. The findings suggested that low dosage, titrated ECT has HR and BP effects similar to traditional high dosage techniques, and that pre-treatment HR is the best predictor of these effects.