Bradycardia at Seizure Termination-Case Report

Out on PubMed, from clinicians in Japan, is this case report:Severe bradycardia at the termination of seizure during electroconvulsive therapy.

Kadoi Y, Michizaki M, Saito T, Ota J, Saito S, Sameshima T.JA Clin Rep. 2020 Oct 16;6(1):83. doi: 10.1186/s40981-020-00389-6.PMID: 33067732
The abstract is copied below:
Background: Few cases of asystole or severe bradycardia occurring after the termination of seizure in the third phase with the dominance of parasympathetic nervous system activity during electroconvulsive therapy (ECT) have been reported. We describe a case of severe bradycardia occurring at the termination of seizure.

Case presentation: The patient had been diagnosed with bipolar disorder more than 9 years earlier. No adverse hemodynamic events had been observed in over 100 sessions of ECT performed during a 9-year period. ECT was usually induced by propofol and suxamethonium. On this ECT, the heart rate gradually decreased before seizure termination, and severe bradycardia (5-6 beats/min) was identified lasting 15-20 s. Atropine administration immediately before electrical stimulus prevented any further bradycardia during the next session of ECT.

Conclusions: This case report indicates that attention should be paid to adverse cardiac events related to autonomic nerve activity even before such events occur during ECT.

Keywords: Autonomic nerve system; Electroconvulsive therapy; Severe bradycardia.

The pdf is here.

This is a well-written and well-presented case report. The 2-channel EEG and ECG tracings from the ECT device (Thymatron) are excellent.
We are reminded that bradycardia, although most commonly seen immediately after stimulus termination (and particularly after subconvulsive stimuli), can also occur later, with seizure termination.
Please see also:
The Brady Bunch: A Montage of Typical Sinus Pauses in Electroconvulsive Therapy.
Kellner CH, Paparone P.J ECT. 2020 Jun;36(2):88-93. PMID: 31094875 
for examples of various degrees of severity of post-stimulus bradycardia.

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