Cardiovascular Side Effects of ECT: New Review in JECT

 Out on PubMed, from investigators at Emory University, in JECT, is this review:

The Cardiovascular Side Effects of Electroconvulsive Therapy and Their Management.

Hermida AP, Mohsin M, Marques Pinheiro AP, McCord E, Lisko JC, Head LW.J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000802. Online ahead of print.PMID: 3469939

The abstract is copied below:
Electroconvulsive therapy (ECT) remains stigmatized in the broader medical community because of misunderstandings about treatment procedures, mortality rates, and cardiovascular complications. Electroconvulsive therapy causes periprocedural hemodynamic variability because of the surges in parasympathetic and sympathetic nervous systems after the administration of the electrical charge. Patients experience an increase in cardiac workload, which is potentially dangerous for patients with preexisting heart disease. Several findings suggest that cardiac complications occur most frequently in patients with underlying cardiovascular disease. We describe the cardiovascular complications that may result from ECT treatment and offer insight on how to mitigate these concerns if they occur. PubMed was queried using terms "electroconvulsive therapy" and "cardiovascular adverse effects." A table is provided with the common cardiovascular side effects of ECT and the most recent evidence-based treatment strategies to manage them. Generally, ECT is a safe procedure in which complications are minor and manageable. Most major complications caused by ECT are related to the cardiovascular system; however, with an appropriate pre-ECT evaluation and a comprehensive multidisciplinary team approach, the cardiovascular complications can be well managed and minimized. Providing proper cardiac clearance can prevent cardiac complications and provide timely care to treatment-resistant populations who are at risk for excessive morbidity and suicide.

And excerpts from the text:


This is a really excellent review of cardiovascular side effects of ECT. It could be subtitled, "Ode to Beta Blockers, Especially Esmolol." But seriously, this is an extremely helpful review, with good, common sense recommendations for management. I have a couple of minor comments: 1) dexmedetomidine (nicely discussed in this review) is a very interesting agent; I am curious to see if it will become more commonly used in conjunction with ECT,  and 2) there is only brief mention of implantable cardiac devices; questions about management of  pacemakers  and defibrillators are very common and it would be helpful to have more information on this topic in such a review.
I recommend a full read of this paper to all healthcare personnel involved with ECT, particularly ECT practitioners, anesthesiologists and cardiologists, ~20 minutes.

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