Assessment of QT Interval and QT Dispersion During Electroconvulsive Therapy Using Computerized Measurements

Tezuka, Nobuko; Egawa, Hirotoshi; Fukagawa, Daigo; Yamaguchi, Shigeki; Hamaguchi, Shinsuke; Kitajima, Toshimitsu; Minami, Junichi

doi:10.1097/yct.0b013e3181a95dbe

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…With respect to the QTc interval, it has been pointed out that mECT can provoke prolongation of QTc intervals [17,18]. In our patient, the QTc interval spread to 0.46 s following the convulsions.…”

Section: Discussionmentioning

confidence: 89%

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

et al. 2011

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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.

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Section: Discussionmentioning

confidence: 89%

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

et al. 2011

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“…Therefore, it is necessary to consider the effects of autonomic nervous system activity or catecholamine secretion from the adrenal medulla in response to remifentanil and mECT. Fourth, various antidepressants and antipsychotics may prolong the QT and increase the QTd prior to mECT, as shown in our previous report [15]. In fact, the prolongation in QT and QTd in patients taking these drugs prior mECT was enhanced by electrical stimulation under anesthesia in our previous report.…”

Section: Discussionmentioning

confidence: 75%

“…In addition, QT and QTD appear to correlate with autonomic regulation instability [4][5][6] and are potential causes of ventricular arrhythmias [7] or severe cardiac adverse events [8], such as myocardial infarction or cardiac sudden death [9][10][11][12][13]. In addition, several reports have indicated that both values increase as a result of various perioperative surgical procedures [14,15].…”

Section: Introductionmentioning

confidence: 99%

Remifentanil can Prevent the Increase in Qt Dispersion During Modified Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

Kageyama¹,

Hamaguchi²

2015

J Anesth Clin Res

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Objective: To clarify the hemodynamic-stabilizing effect of remifentanil in the context of modified electroconvulsive therapy (mECT), we measured electrocardiographic alterations in the corrected QT interval (QTc) and corrected QT dispersion (QTcD), considered predictive of ventricular arrhythmia, during mECT. Methods:Sixty patients scheduled for mECT were divided randomly into 3 groups. Patients in the low-dose remifentanil administration group (group L, N=20) were administered 0.5 μg/kg of remifentanil before mECT. Patients in the high-dose group (group H, N=20) were administered 1.0 μg/kg of remifentanil, and those in the control (group C, N=20) were administered a similar volume of normal saline solution. Modified ECT was performed in the same manner in all groups with propofol and suxamethonium. Changes in QTc and QTcD values were analyzed using a repeated measures analysis of variance, and between-group comparisons were conducted using the Bonferroni method.Results: During mECT, an increase in the mean arterial pressure, decrease in the R wave-to-R wave interval, elongation of QTc, and increase in QTcD were observed in group C, whereas these alterations were attenuated in group L and were not observed in group H. The differences observed in group C relative to the other groups were statistically significant (P<0.05). Conclusion:Compared with the control treatment and a 0.5 μg/kg dose, a 1.0 μg/kg dose of remifentanil had a preventive effect on ventricular arrhythmia after mECT, as well as on hemodynamic changes, according to the observed alterations in QTc and QTcD. Therefore, our results indicate that a 1.0 μg/kg dose of remifentanil could suppress hemodynamic changes, prevent myocardial ischemia or cerebral hemorrhage, and minimize the development of fatal arrhythmias such as ventricular tachycardia and/or ventricular fibrillation.

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“…A QTc greater than 500 ms has been reported to be highly abnormal for both men and women by guidelines provided by the Food and Drug Administration in 2012 . Moreover, QTc has been reported to possibly change dramatically and rapidly (i.e., within minutes) during ECT . Thus, QTc should be monitored with high time resolution to detect the high‐risk period (i.e., periods when QTc increases by more than 500 ms) to prevent fatal arrhythmia during ECT.…”

Section: Discussionmentioning

confidence: 99%

Is prolongation of corrected QT interval associated with seizures induced by electroconvulsive therapy reduced by atropine sulfate?

Suzuki

Miyajima

Ohta

et al. 2017

Pacing Clinical Electrophis

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Assessment of QT Interval and QT Dispersion During Electroconvulsive Therapy Using Computerized Measurements

Abstract: The QTc interval, QTD, and QTcD, which were associated with increased risks of ventricular arrhythmias, increased significantly before anesthetic induction in patients with major depression. Electrical stimulus during ECT induced further increases of the QTD and QTcD.

Cited by 14 publications

References 32 publications

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

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

Remifentanil can Prevent the Increase in Qt Dispersion During Modified Electroconvulsive Therapy: A Randomized Controlled Clinical Trial

Is prolongation of corrected QT interval associated with seizures induced by electroconvulsive therapy reduced by atropine sulfate?

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