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Frequency of left ventricular dysfunction after electroconvulsive therapy

      Electroconvulsive therapy (ECT) is first-line treatment for depressed patients who are suicidal, severely agitated, catatonic, or psychotic.
      American Psychiatric Association
      Practice guideline for major depressive disorder in adults.
      It is also used as an alternative to conventional antidepressant medications when these are poorly tolerated or ineffective.
      American Psychiatric Association
      Practice guideline for major depressive disorder in adults.
      ,
      Consensus Conference
      Electroconvulsive therapy.
      ,
      American Psychiatric Association Task Force on ECT
      The practice of ECT recommendations for treatment, training and privileging.
      ECT is a safe procedure, with a mortality rate per treatment of 0.002%.
      • Kramer B.A.
      Use of ECT in California, 1977–1983.
      ,
      • Abrams R.
      The mortality rate with ECT.
      Major cardiac events, although uncommon, can occur after ECT.
      • Gerring J.P.
      • Shields H.M.
      The identification and management of patients with a high risk for cardiac arrhythmias during modified ECT.
      ,
      • Regestein Q.R.
      • Reich P.
      Electroconvulsive therapy in patients at high risk for physical complications.
      ,
      • Hay D.P.
      Electroconvulsive therapy in the medically ill elderly.
      ,
      • Zielinski R.J.
      • Roose S.P.
      • Devanand D.P.
      • Woodring S.
      • Sackeim H.A.
      Cardiovascular complications of ECT in depressed patients with cardiac disease.
      ,
      • Rice E.H.
      • Sombrotto L.B.
      • Markowitz J.C.
      • Leon A.C.
      Cardiovascular morbidity in high-risk patients during ECT.
      ECT-associated electrocardiographic (ECG) abnormalities are common,
      • Gould L.
      • Gopalaswamy C.
      • Chandy F.
      • Kim B.
      Electroconvulsive therapy-induced ECG changes simulating a myocardial infarction.
      ,
      • Dec Jr, G.W.
      • Stern T.A.
      • Welch C.
      The effects of electroconvulsive therapy on serial electrocardiograms and serum cardiac enzyme values. A prospective study of depressed hospitalized inpatients.
      but it is not known how sensitive or specific these are as indicators of myocardial dysfunction. Transient left ventricular (LV) systolic dysfunction after ECT has been observed in some patients on echocardiography.
      • Volz H.P.
      • Linden M.
      Electroconvulsive therapy-induced cardiac decompensation.
      ,
      • Zhu W.X.
      • Olson D.E.
      • Karon B.L.
      • Tajik A.J.
      Myocardial stunning after electroconvulsive therapy.
      ,
      • Messina A.G.
      • Paranicas M.
      • Katz B.
      • Markowitz J.
      • Yao F.S.
      • Devereux R.B.
      Effect of electroconvulsive therapy on the electrocardiogram and echocardiogram.
      ,
      • O’Connor C.J.
      • Rothenberg D.M.
      • Soble J.S.
      • Macioch J.E.
      • McCarthy R.
      • Neumann A.
      • Tuman K.J.
      The effect of esmolol pretreatment on the incidence of regional wall motion abnormalities during electroconvulsive therapy.
      ,
      • Fuenmayor A.J.
      • el Fakih Y.
      • Moreno J.
      • Fuenmayor A.M.
      Effects of electroconvulsive therapy on cardiac function in patients without heart disease.
      A case report of a patient at our institution who developed severe, but ultimately reversible, LV systolic dysfunction after ECT (without elevation of creatine kinase or its cardiac isoenzyme, creatine kinase-MB) was published in 1992.
      • Zhu W.X.
      • Olson D.E.
      • Karon B.L.
      • Tajik A.J.
      Myocardial stunning after electroconvulsive therapy.
      We undertook this prospective, observational study to determine the frequency and course of ECT-associated LV systolic dysfunction.
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