Electroconvulsive Therapy in the Setting of Implantable Cardioverter-Defibrillators

Abstract

Electroconvulsive therapy has potent cardiovascular effects, which may pose a challenge in treating patients with preexisting cardiac disease. Although it is well studied in the treatment of refractory depression, there are still pitfalls to overcome when treating those with comorbid cardiovascular disease. The synergistic effects of depression and cardiovascular disease in affecting the morbidity and mortality of patients make treatment a significant issue. The authors discuss 3 elderly patients treated for major depression, all of whom previously had implantable cardioverter-defibrillators placed. All 3 patients were effectively treated, with no major adverse effects. The cases illustrate how taking the appropriate preventative measures allow even the most medically challenging patient to undergo effective treatment and highlight the debate surrounding the intraoperative management of implantable cardioverter-defibrillator devices.

Cardiac Rhythm Management Devices and Electroconvulsive Therapy

“…47 Thus, Pornnoppadol and Isenberg 18 did not deactivate the ICD, mentioning that an inappropriate ICD activation would minimally distress an anesthetized patient. In later reports however, 9,16,48,49 a different risk assessment was adopted: authors suggest that the probability of an ICD misinterpreting common benign tachyarrhythmias is relatively higher than the probability of truly developing VT/VF during ECT, and an unnecessary discharge from the ICD because of misinterpreted signals might initiate a true ventricular arrhythmia.…”

The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management

“…Importantly, despite a theoretical risk, no patients developed cardiogenic shock from decreased cardiac contractility. Davis et al 108 discussed 3 elderly patients who had implantable cardioverter defibrillators and were effectively treated with ECT without complications. Cases have been reported where ECT was administered to patients with unrepaired abdominal aortic aneurysms with use of β-blockers to prevent tachycardia and/or elevations in systolic or diastolic BP 109–112 .…”