ECT and A Fib: Case Report
Out on PubMed, from clinicians in California, is this case report:
New Onset Paroxysmal Atrial Fibrillation After Electroconvulsive Therapy.
Cureus. 2020 Nov 26;12(11):e11717. doi: 10.7759/cureus.11717.PMID: 33391948
The abstract is copied below:
Electroconvulsive therapy (ECT) is a safe treatment for various psychiatric disorders. During an ECT treatment, an electrical stimulus produces a transient sympathetic response leading to changes in the cardiac rate and rhythm. Rarely, ECT treatment may precipitate atrial fibrillation (AF). In this case report, we present a 70-year-old man with schizoaffective disorder who developed paroxysmal AF after his 38th ECT treatment. We review his risk factors for AF and propose a possible mechanism of its development. We also discuss potential treatment options to safely resume ECT treatments.
This case report, first-authored by a medical student, documents the transient emergence of atrial fibrillation after an ECT treatment. The report is well written, but does not say how long the a fib lasted, what, if any, ongoing treatment was recommended, and whether ECT was subsequently resumed. It would have been nice to have some discussion of the "new" generation of anticoagulation medications and explicit mention of the clinical need to get a cardiology consultation (perhaps implied, as obviously indicated).
The curious thing about ECT and a-fib is that it can go in either direction. Both sympathetic and parasympathetic surges occur at various phases in the ECT session. I have seen patients in normal sinus rhythm (NSR) go into a-fib during ECT.... and I have seen patients in a-fib revert to NSR. The latter instance emphasizes the need to assure good anticoagulation in the a-fib patient undergoing ECT, lest they revert to a-fib and risk mobilation of a mural clot.
ReplyDelete-Vaughn McCall