Electroconvulsive therapy (ECT) is a safe treatment process in which the risk entailed is said to be generally no greater than that associated with the use of short-acting barbiturates l-4 • Opinions differ as to the relative safety of electroconvulsive therapy in debilitated patients or in those with severe myocardial dysfunction. Gerring and Shields 5 identified a group of patients at high risk for the development of cardiovascular complications, namely myocardial ischaemia and/or arrhythmias following electroconvulsive therapy. In this group, which included patients with a history of angina, myocardial infarction, congestive heart failure, arrhythmias, rheumatic heart disease or an abnormal baseline electrocardiogram, the complication rate was 70%. However, Dec et al. 2 found electroconvulsive therapy to be safe, effective and well tolerated in a group of elderly debilitated patients, one-quarter of whom had severe cardiovascular disease including poor ejection fractions and recent myocardial infarctions.