Cardiovascular Alterations During Electroconvulsive Therapy in Patients with Cardiac Pacemakers

Cr, Youmans; Bourianoff, G G; Dc, Allensworth; Martin, W; Derrick,

doi:10.1097/00007611-197203000-00026

Cited by 5 publications

(3 citation statements)

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“…Indeed, it was reported as early as 1968 that ECT can safely be administered on a patient with an asynchronous fixed-rate pacemaker. 21 That report was soon followed by a similar one and an experimental study on dogs by Youmans et al 22,23 documenting the feasibility of performing ECT on depressed patients, despite some pacemaker interference from the ECT stimulus. However, Gibson et al 24 reported a year later that the ECT stimulus caused such artifacts that raised suspicion of interference with the sensing function of the modern, at that time, demand pacemakers.…”

Section: Discussionmentioning

confidence: 93%

Cardiac Rhythm Management Devices and Electroconvulsive Therapy

et al. 2011

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Electroconvulsive therapy (ECT) is an effective treatment and, with the proper risk-minimizing strategies, is relatively safe even in depressed patients with cardiovascular diseases. Specifically, patients with cardiac rhythm management devices (CRMDs) require particular attention because no controlled trials exist to support current empirical recommendations. We present a depressed patient with a pacemaker successfully treated with ECT, and we critically review the relevant literature. Pooled results from 63 patients and 821 ECT sessions showed that 90% of ECT sessions have been performed on depressed patients with their pacemakers in sensing mode and rate adaptation, where available, activated as well. Only 4% of sessions were performed with those functions disabled, whereas no data was available for 6% of ECT sessions. Pooled results from case series and reports highlight a discrepancy between current clinical practice and many guidelines. Electroconvulsive therapy is probably safe in depressed patients with asynchronous fixed-rate pacemakers, although there is a risk of ventricular tachycardia and fibrillation. A larger body of case series and reports suggests that there might be no need to convert synchronous demand pacemakers to asynchronous fixed-rate pacing. Regarding patients with implantable cardioverter defibrillators, antitachycardia treatment was deactivated during most ECT sessions. In depressed patients with CRMDs anticholinergics might be best avoided. In all cases, proper ECT procedures, namely, patient and pacemaker electrical isolation, strict grounding and adequate muscle relaxation along with interrogation and monitoring of CRMDs before and after each session should ensure uncomplicated electroconvulsive treatments.

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Section: Discussionmentioning

confidence: 93%

Cardiac Rhythm Management Devices and Electroconvulsive Therapy

et al. 2011

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“…There are 8 reports of 9 pacemaker patients receiving ECT (Table II). 2–6,8,12,17 No one had apparent complications. During ECT only a minimum amount of electricity reaches the heart due to high tissue resistance.…”

Section: Discussionmentioning

confidence: 98%

“…It is not uncommon in ECT practice to encounter a patient with either a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). In the relatively few case reports of the use of ECT in patients with an implanted cardiac device, ECT appears to be safe 2–13 . In reviewing the database of our tertiary care referral center, we found records for 29 cardiac device patients who had undergone ECT, 26 of whom had a cardiac pacemaker and 3 of whom had an ICD.…”

Section: Introductionmentioning

confidence: 99%

Electroconvulsive Therapy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators

Dolenc¹,

Barnes²,

Hayes

et al. 2004

Pacing Clinical Electrophis

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Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.

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