The pulse width of 0.5 msec is more efficient than the 1-msec pulse width. The "half-age" dose for the first bilateral ECT treatment is usually successful for subsequent ECTs when the 0.5-msec pulse width is used.

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A man in his 20s presented with syncope and shortness of breath. Electrocardiography revealed monomorphic ventricular tachycardia. Echocardiographydemonstratedseverebiventriculardysfunctionwith normal ventricular size and thickness. Septal e' was 5 cm/s, mitral valve inflow deceleration time was 120 milliseconds, E/e' was 18, and lateral s' was 6 cm/s. An endomyocardial biopsy did not show any specific pathology. In this patient with severe heart failure, ventricular arrhythmias, and unrevealing biopsy, what should be the next step? Thepatientsubsequentlydevelopedworseningcardiogenicshock and developed ventricular fibrillation that required temporary biventricular assist device implantation (Figure, A, Video). A repeated biopsy obtained during biventricular assist device implantation confirmed presence of giant cells (Figure, B). Immunosuppression was initiated, but the patient died.Sensitivity of endomyocardial biopsy for giant cell myocarditis is only 68%; repeated biopsy should be considered if there is a high index of suspicion. 1 Biventricular assist devices can provide robust support but have a high rate of complications.