A case of nonsustained ventricular tachycardia immediately following modified electroconvulsive therapy in a depressive patient

Abstract

Modified electroconvulsive therapy (mECT) with the use of hypnotics and muscle relaxants is an optional and prevailing treatment for depression in patients who have failed on antidepressant regimens. We describe a patient who developed ventricular tachycardia (VT) immediately after mECT. A 64-year-old man with no remarkable past history underwent a course of mECT for drug-resistant depression. Anesthesia was induced with intravenous thiopental (150 mg) followed by rocuronium (50 mg). Three minutes after the administration of rocuronium, the brain was electrically stimulated using a pulse wave. The first mECT session was performed uneventfully. However, the second session 2 days later elicited acute hypertension (182/134 mmHg) and tachycardia (130 bpm), resulting in the appearance of single and couplets of premature ventricular contractions on the electrocardiogram followed by VT lasting about 10 s. The chest was immediately compressed several times, then normal sinus rhythm was spontaneously restored without administering antiarrhythmic agents. The patient recovered from anesthesia without complications. Postoperatively, close examination was unable to definitively determine the cause of VT, resulting in the cancellation of subsequent mECT sessions. It is important to bear in mind that mECT can induce life-threatening arrhythmias such as VT.

Ventricular tachycardia triggered by electroconvulsive therapy: Case report and review of the literature

“…A literature search on MEDLINE using the combined terms of ECT and VT, revealed a total of eight relevant published case reports. [5][6][7][8][9][10][11][12] The findings of each study are summarized in Table 1. Of all of these prior case reports of Further ECT was not re-attempted.…”

“…A literature search on MEDLINE using the combined terms of ECT and VT, revealed a total of eight relevant published case reports 5–12 . The findings of each study are summarized in Table 1.…”

“…Finally, several authors highlight the possible trigger of atropine use prior to ECT, which is a common practice used to prevent post‐ictal bradyarrhythmias and to reduce respiratory secretions that could lead to aspiration events 13 . In these cases, the authors propose that atropine exaggerates the sympathetic response which thereby leads to ventricular ectopy 7–9,12 . As such, the use of beta‐adrenergic blockers, such as esmolol 12 or landiolol, 7 have been postulated as a means to mitigate this adverse autonomic response and thereby prevent VT.…”

“…A literature search on MEDLINE using the combined terms of ECT and VT, revealed a total of eight relevant published case reports. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 The findings of each study are summarized in Table 1 . Of all of these prior case reports of VT associated with ECT, none of the patients were known to have significant underlying structural heart disease.…”

“…13 In these cases, the authors propose that atropine exaggerates the sympathetic response which thereby leads to ventricular ectopy. 7 , 8 , 9 , 12 As such, the use of beta‐adrenergic blockers, such as esmolol 12 or landiolol, 7 have been postulated as a means to mitigate this adverse autonomic response and thereby prevent VT.…”